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Tag: epidemics and outbreaks

  • Mpox in the United States Fast Facts | CNN

    Mpox in the United States Fast Facts | CNN



    CNN
     — 

    Here’s a look at mpox, formerly known as monkeypox, in the United States. In 2022, an outbreak was declared a public health emergency of international concern by the World Health Organization (WHO). The virus originated in Africa and is the cousin of the smallpox virus.

    In November 2022, WHO renames the monkeypox virus as mpox after working with International Committee on the Taxonomy of Viruses (ICTV) to rename the the virus using non-stigmatizing, non-offensive social and cultural nomenclature.

    (Source: Centers for Disease Control and Prevention)

    Mpox is a poxvirus. It generally causes pimple- or blister-like lesions and flu-like symptoms such as fever. The disease is rarely fatal.

    Mpox spreads through close contact. This includes direct physical contact with lesions as well as “respiratory secretions” shared through face-to-face interaction and touching objects that have been contaminated by mpox lesions or fluids. The virus may also pass to a fetus through the placenta.

    Anyone can become ill from mpox, but the US Centers for Disease Control and Prevention (CDC) says that more than 99% of mpox cases in the United States in the 2022 outbreak have been among men who have sex with men. However, mpox is not generally considered a sexually transmitted disease.

    Mpox is usually found in West and Central Africa, but additional cases have been seen in Europe, including the United Kingdom, and other parts of the world in recent years. Those cases are typically linked to international travel or imported animals infected with the poxvirus.

    CDC Mpox Map and Case Count

    WHO Situation Reports

    Timeline and 2022 Outbreak

    1958 – Mpox is discovered when monkeys kept for research cause two outbreaks in Copenhagen, Denmark.

    1970 – The first human case is recorded in Zaire (now the Democratic Republic of Congo).

    2003 – An outbreak in the United States is linked to infected pet prairie dogs imported from Ghana and results in more than 80 cases.

    July 16, 2021 – The CDC and local health officials in Dallas announce they are investigating a case of mpox in a traveler from Nigeria. “The individual is a City of Dallas resident who traveled from Nigeria to Dallas, arriving at Love Field airport on July 9, 2021. The person is hospitalized in Dallas and is in stable condition,” the Dallas County Department of Health and Human Services says in a statement.

    May 17, 2022 – The first confirmed US case of mpox in the 2022 outbreak is reported to the CDC in a traveler who returned to Massachusetts from Canada.

    May 19, 2022 – WHO reports that death rates of the outbreak have been between 3% and 6%.

    May 23, 2022 – The CDC announces the release of mpox vaccine doses from the nation’s Strategic National Stockpile for “high-risk people.” In the United States, the two-dose Jynneos vaccine is licensed to prevent smallpox and specifically to prevent mpox.

    May 26, 2022 – CDC Director Dr. Rochelle Walensky announces that the United States is distributing the vaccine to states with reported cases and recommends vaccination for people at highest risk of infection due to direct contact with someone who has mpox.

    June 22, 2022 – The CDC announces a partnership with five commercial laboratories to ramp up testing capacity in the United States.

    June 23, 2022 – New York City launches the first mpox vaccination clinic in the United States.

    June 28, 2022 – The US Department of Health and Human Services (HHS) and the Biden administration announce an enhanced vaccination strategy and report that more than 9,000 doses of vaccine have been distributed to date.

    July 22, 2022 – Two American children contract mpox – a first in the United States. According to the CDC, the two cases are unrelated.

    July 23, 2022 – WHO declares mpox a public health emergency of international concern, “an extraordinary event that may constitute a public health risk to other countries through international spread of disease and may require an international coordinated response.”

    July 27, 2022 – After weeks of mpox vaccines being in limited supply, more than 786,000 additional doses are made available in the United States, according to HHS.

    July 29, 2022 – New York declares a state disaster emergency in response to the mpox outbreak.

    August 1, 2022 – California and Illinois declare states of emergency. California has reported more than 800 cases, while Illinois has had more than 500, according to data from the CDC.

    August 2, 2022 – An mpox response team is created by the Biden administration. President Joe Biden names Robert Fenton from the Federal Emergency Management Agency (FEMA) as the White House national mpox response coordinator.

    August 2, 2022 – A report from Spain’s National Institute for Microbiology indicates two men, ages 31 and 44, who died from mpox in unrelated cases had both developed encephalitis, or swelling of the brain, which can be triggered by viral infections. Encephalitis is a very rare condition known to be associated with mpox. It has been reported in people with mpox in West Africa and in a patient in the United States in 2003 during the small outbreak linked to imported prairie dogs.

    August 4, 2022 – The Biden administration declares the mpox outbreak a national public health emergency.

    August 5, 2022 – A report published by the CDC finds that 94% of cases were among men who had recent sexual or close intimate contact with another man. Further, 54% of cases were among Black Americans and Latinos.

    August 9, 2022 – In an effort to stretch the limited supply of the Jynneos mpox vaccine, federal health officials authorize administering smaller doses using a different method of injection. The new injection strategy allows health-care providers to give shallow injections intradermally, in between layers of the skin, with one-fifth the standard dose size instead of subcutaneously, into the fatty layer below the skin, with the larger dose.

    August 18, 2022 – The White House announces the acceleration of the HHS vaccine distribution timeline, with an additional 1.8 million doses of the Jynneos vaccine being made available. Additional vaccines will be distributed to communities hosting large LGBTQI+ events.

    August 19, 2022 – Washington’s King County, which includes Seattle, declares mpox a public health emergency, with more than 270 recorded cases.

    September 12, 2022 – The first US death due to mpox is confirmed in Los Angeles County, California.

    May 11, 2023 – WHO declares the mpox outbreak is no longer a global health emergency.

    October 26, 2023 – CDC’s Advisory Committee on Immunization Practices, or ACIP, votes unanimously to recommend that certain individuals ages 18 and older who are at high risk for getting mpox continue to get the vaccine as a routine part of their sexual health care.

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  • This city never slept. But with China tightening its grip, is the party over? | CNN Business

    This city never slept. But with China tightening its grip, is the party over? | CNN Business

    Editor’s Note: Sign up for CNN’s Meanwhile in China newsletter which explores what you need to know about the country’s rise and how it impacts the world.


    Hong Kong
    CNN
     — 

    As the scattered patrons hop from one deserted bar to the next, it’s hard to believe the near-empty streets they are zigzagging down were once among the most vibrant in Asia.

    It is Thursday evening, a normally busy night, but there are no crowds for them to weave through, no revelers spilling onto the pavements and no need for them to wait to be seated. At some of the stops on this muted bar crawl, they are the only ones in the room.

    It wasn’t always this way. It might seem unlikely from this recent snapshot, but Hong Kong was once a leading light in Asia’s nightlife scene, a famously freewheeling neon-lit city that never slept, where East met West and crowds would spill from the bars throughout the night and long into the morning – even on a weekday.

    Such images were beamed around the world in 1997, when Britain handed over sovereignty of its prized former colony to China, and locals and visitors alike welcomed in the new era with a 12-hour rave featuring Boy George, Grace Jones, Pete Tong and Paul Oakenfold.

    China’s message at the time was that even if change was coming to Hong Kong, its spirit of “anything goes” would be staying put. The city was promised a high degree of autonomy for the next 50 years and assured that its Western ways could continue. Or, as China’s then leader Deng Xiaoping put it: “Horses will still run, stocks will still sizzle and dancers will still dance.”

    And for long after the British departed, the dancing did indeed continue. Hong Kong retained not only the spirit of capitalism, but many other freedoms unknown in the rest of China – not just the gambling on horse races that Deng alluded to, but political freedoms of the press, speech and the right to protest. Even calls for greater democracy were tolerated – at least, for a time.

    But little more than halfway into those 50 years, Deng’s promise now rings hollow to many. Spasms of mass protests – against “patriotic education” legislation in 2012, the Occupy Central movement in 2014 and pro-democracy demonstrations in 2019 – led China to restrict civil liberties with a sweeping National Security Law. Hundreds of pro-democracy figures have since been jailed and tens of thousands of residents have headed for the exits.

    That crackdown and Hong Kong’s fading freedoms have been well-documented, but it is only more recently that a less-reported knock-on effect of China’s crackdown has started to emerge: In the streets and the bars, the trendy clubs and Michelin-starred restaurants, the city that never slept has begun to doze.

    Nightlife in the city has become a pale shadow of its heyday as a regional rest and relaxation magnet, when its reputation rested on it being easier to navigate than Japan, less boring than Singapore and freer than mainland China.

    Now, apparently in tandem with the diminishing political freedoms, business in the city’s once-thriving bars is drying up. And while some argue over whether politics or Covid is at fault, few dispute that something needs to be done.

    Bars earned about $88.9 million in the first half of 2023, 18% less than the $108.5 million brought in during the same period in 2019, according to official data.

    In an effort to arrest the decline, the Hong Kong government has launched a “Night Vibes” campaign featuring bazaars at three waterfront areas, splurged millions on a recent fireworks show to celebrate China’s National Day and reintroduced a dragon dance, lit by incense sticks, in its neighborhood of Tai Hang.

    Those efforts have attracted a mixture of criticism and mockery – with many pointing out the irony of the campaign’s opening ceremony featuring two white lions, a color associated in Chinese culture with funerals. Meanwhile, the bazaars have been interrupted by a mix of typhoons and security concerns over the use of fireworks.

    Still, Hong Kong’s Chief Executive John Lee insists the events are a success, saying at least 100,000 people have checked out the bazaars and that 460,000 tourists from mainland China visited for National Day. And the white lions? Officials say they were “fluorescent.”

    A Hong Kong government spokesman told CNN this week that the activities were “well-received by local residents and tourists”. A recent Hong Kong Wine & Dine Festival brought in 140,000 patrons and shopping malls supporting the Night Vibes campaign said they had seen “growth in visitor flow and turnover,” he added.

    A man walks past a closed bar along a near-empty street in the Soho area of Hong Kong.

    There are some who point the finger solely at Covid.

    “It’s obvious that it’s worse than before. This is the side effect of Covid, which has changed the way of life,” said Gary Ng, an economist with French investment bank Natixis.

    And few would dispute that Covid took its toll. During the pandemic, Hong Kong made a virtue of cleaving closely to a mainland Chinese-style zero-tolerance approach that, though not quite as draconian, was still extreme enough to send large numbers of expatriates heading for the exit, with many of them decamping to rival Asian cities like Singapore, Thailand and Japan.

    Hong Kong, where incoming travelers faced weeks in quarantine and restaurant tables were limited to two customers, was suddenly the boring one and Singapore – in a telling comparison – the more lively.

    Under Hong Kong’s pandemic restrictions, live music was all but banned in small venues for more than 650 days.

    But others say Hong Kong is in denial and that its nightlife problems go much deeper than the pandemic. Other places have recovered, they say, why not Hong Kong?

    These observers note the city’s response to Covid should itself be seen through the lens of the city’s ever disappearing freedoms.

    Months before the virus emerged, China had been tightening its grip on Hong Kong in response to pro-democracy protests that had spread throughout the city.

    It introduced restrictions on freedoms – such as of expression and of the press – which were supposedly guaranteed at the time of the handover.

    Songs and slogans perceived as linked to the protests were outlawed, memories of past protests scrubbed from the internet, sensitive films censored and newspaper editors charged with sedition and colluding with foreign forces.

    The government has maintained that legal enforcement is necessary for Hong Kong to restore stability and prosperity and stop what China says is “foreign forces” from meddling in the city.

    “We strongly disapproved of and firmly rejected those groundless attacks, slanders and smears against the HKSAR on the protection of such fundamental rights and freedoms in Hong Kong,” a spokesman said, referring to Hong Kong’s official name, in a reply to CNN.

    But, the critics hit back, none of that lends itself to an atmosphere where people will want to sit back, relax and shoot the breeze.

    “People may feel like they have to self-censor when having a chat at restaurants or bars because, who knows who may be listening. They may as well stay home for the same chat where they feel safe,” said Benson Wong, one of the hundreds of thousands who have left Hong Kong.

    Wong, a former associate professor who specialized in local politics, said he used to enjoy eating out at dai pai dongs – open-air stalls selling Cantonese classics and (usually) plenty of beer – where patrons once talked freely about everything from celebrity gossip to politics.

    Now though, he said, “one won’t feel happy if they have to watch everything they say.”

    A man sits inside a bar in Lan Kwai Fong, Hong Kong's renowned nightlife hub.

    Whether it was Covid or the crackdown, or some combination of the two, an exodus of middle-class Hong Kongers and affluent expats has taken place in recent years.

    Last year, the city saw a net outflow of 60,000 residents, its third drop in as many years, taking the number of usual residents down to 7.19 million as of the end of 2022 — a drop of almost 144,000 from the end of 2020.

    Tens of thousands of them are Hong Kongers who have taken up special visas and pathways to citizenship offered by Western countries such as Britain, Canada and Australia in the wake of China’s crackdown.

    But there has also been a steady drip of departures from the expat population that, like a post-colonial hangover, had remained in the city long after Britain’s departure. They were largely professionals in finance and law with a reputation for working hard and partying even harder, regardless of the politics.

    Local media is now awash with reports of banking and law firms relocating their offices, in part or full, to rival financial hubs such as the no-longer-boring Singapore.

    Unfortunately for bar and restaurant owners, the two demographics leaving are among their biggest customers.

    “The expats have relocated, as well as [Hong Kongers] with a higher income. Their departure of course will have an impact,” said Ng, from Natixis.

    Increasingly, these two groups are being replaced by people from mainland China, who now account for more than 70% of the 103,000 work or graduate visas granted since 2022, according to the Immigration Department. The newly dominant migrants, economists point out, tend to have very different spending habits.

    Yan Wai-hin, an economics lecturer at the Chinese University of Hong Kong, said the city’s previously robust nightlife was propped up largely by a base of expats and middle-class locals steeped in the time-honored drinking culture of enjoying a nice cold one after a long day.

    “The makeup of the population is different now,” Yan said. “Now we have more immigrants from the mainland, and they tend to love to go back to mainland China to spend instead.”

    At Hong Kong’s most famous nightlife district, Lan Kwai Fong, the music may be fading, but it hasn’t stopped completely.

    The area was long synonymous with jam-packed streets of revelers who would spill out from the bars as the air filled with the sounds of boisterous chatter, clinking glasses and dance music blasting away late into the night.

    But during a recent visit by CNN, there was little to distinguish the area from any other street.

    People stand and drink in Lan Kwai Fong in 2017, back when the place was still pumping.

    “It has been very challenging so far and it has not got back to normal by a long shot,” said Richard Feldman, who runs the gay bar Petticoat Lane at the California Tower in Lan Kwai Fong.

    The chairman of the Soho Association, who has been running businesses in the city for more than three decades, Feldman said business was slightly better between Friday and Saturday than weekdays and shops with a good reputation have been less affected.

    But across the board, he too said the number of Western faces were dwindling in what was once a favored expat haunt.

    “It was a mix of expats and local professionals who would go out for drinks and a late night dance. But that demographic has eased quite a bit in the past year,” said another bar owner Becky Lam. “We are getting more mainland customers.”

    Lam, joint founder of a number of Hong Kong bars and restaurants, including wine bar Shady Acres in Central, said while mainland Chinese were willing to spend, they tended to gravitate towards restaurants rather than bars and were less likely to stay out late.

    On a weekday, she said, the bars she runs have been getting only half of the customers compared to pre-pandemic days.

    “They’ll settle for the Happy Hours and that’s it. We are not talking about 2 a.m. to 3 a.m.,” she said.

    There are other problems gnawing away at the nightlife sector.

    “People’s habits have changed since Covid, as many are so used to staying at home watching TV and Netflix,” Feldman said.

    During the pandemic, Hong Kong imposed a lengthy ban on bars and dine-in services to stem social gatherings, in what many saw as a nod to mainland China’s “zero-Covid” strategy.

    This affected shops and malls, which shortened their business hours due to the lack of customers. In many cases, those shortened hours have now become the new normal, with some shops now closing as early as 9 p.m. as opposed to the pre-Covid standard of 10:30 p.m.

    Lan Kwai Fong during its heyday in 2017

    Also conspiring against the city’s nightlife is a strong Hong Kong dollar compared to the Chinese yuan, which affects how both Hong Kongers and potential tourists spend their money.

    “People from the mainland are less likely to come here to shop, while people in Hong Kong are going to Shenzhen to spend their money,” said Marco Chan, head of research at real estate and investment firm CBRE.

    While mainland tourists now think twice about coming to Hong Kong, many Hongkongers have been spending their weekends in mainland China, where many services come at a fraction of the price, Chan said.

    Known as the “Godfather of Lan Kwai Fong,” Allan Zeman – the entrepreneur who turned the small square in Hong Kong’s Central district into a renowned nightlife hub – cuts a more optimistic figure than most and insists business is not as bad as it appears.

    He estimates mainland Chinese customers now account for 35% of the patrons in Lan Kwai Fong and says they are big spenders.

    Allan Zeman, chairman of Lan Kwai Fong Group, says mainland Chinese tourists are still spending generously.

    “They’ll go up to a club, like the California Tower on the roof, and they’ll spend like 400,000 to 550,000 Hong Kong dollars ($51,000 to $70,000) just for drinks,” he said.

    His take is that it is Hong Kong’s strong currency and a relative lack of incoming flights compared to the pre-Covid era that are stalling the city’s comeback. “I think it’s temporary,” he said.

    But bar owner Lam said Hong Kong needs to reexamine its regulatory approach, if it is to thrive at night once more.

    Lam pointed to a drive in recent years by the authorities to remove the city’s famous neon lights in the name of safety as an example of the current misguided approach, saying Hong Kong’s most defining nighttime icons were being dismantled one sign at a time.

    She also said her bar, Shady Acres, had been told to serve customers only indoors and shut all doors and windows after 9 p.m. as part of its licensing requirement.

    “These kinds of hurdles are really big in Hong Kong,” Lam said. “But I look at our neighboring cities like Bangkok, Shanghai and Taipei. These cities have an exciting nightlife as they really make it late night fun with music, street art and late night dining.”

    Feldman, of Petticoat Lane, had another suggestion. “Hong Kong used to be a far more international destination. Now it is a domestic destination,” he said.

    The city, said Feldman, should “do everything it can to attract people not only from China but from all over the world.”

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  • How toy and game companies are winning back their grown-up former customers | CNN Business

    How toy and game companies are winning back their grown-up former customers | CNN Business


    New York
    CNN
     — 

    I was on vacation and hanging out quietly in the hotel room with my friend when, out of nowhere, she screamed “Zoo Pals are back!”

    We immediately tried to buy some. But to our misfortune, they were sold out. For days we refreshed the page to see if they were back in stock. Sure enough, I got my Zoo Pals a few weeks later.

    I’m almost embarrassed to share that Zoo Pals are paper plates that feature the bright, adorable faces of animals like pigs, turtles, ducks and whales. Each plate has one main section and two subsections for the animal’s ears or feet. In 2014, Hefty, the maker of Zoo Pals, discontinued them.

    As a child, Zoo Pals were a game-changer. That meant broccoli didn’t have to, God forbid, touch my chicken nuggets, and they also provided a special area for dipping the nuggets in ketchup. And I had an incentive to finish my plate so I could see my Zoo Pal’s face again.

    As an adult, I no longer have such needs. But $6.99 was a small price to pay for a walk down memory lane.

    Adults are increasingly shelling out for relics of their youth and for items, ranging from flip phones to film cameras to Tamagotchis, that evoke a late 20th-century or turn-of-the century nostalgia. That demand has created a treasure-trove of sales in particular for toys and products, like my Zoo Pals, originally geared to children.

    Toy recipients ages 18 and up — also known as “kidults” — represented about 17% of total toy sales in the United States for the 12 months ending in June 2023, according to data consumer research group Circana shared with CNN. That’s up four percentage points from 2021 and up a whopping eight percentage points from 2019.

    In total, toy sales for adults increased by $1.7 billion to $6.4 billion from June 2021 to June 2023, according to Circana data.

    The trend of adults buying toys for themselves is relatively new, but longing for the glory days of childhood is not. So how come adults lately have been willing to spend so much money on toys to relive the past?

    The pandemic drove more people to revisit their youth

    Adults started purchasing more toys for themselves after the pandemic began. Covid ushered in heightened levels of anxiety and it caused people to think about dying more, explains Krystine Batcho, a licensed psychologist who teaches at Le Moyne College in Syracuse, New York.

    Both factors are associated with “greater nostalgia,” said Batcho, whose research focuses on the psychology of nostalgia. Batcho created the Nostalgia Inventory, a survey that’s been widely used to assess what makes someone more inclined to feel nostalgic.

    For instance, her research and other research she’s studied point to millenials and members of Gen Z being in life stages that are prime for feeling nostalgic. “The transition away from childhood and adolescence to adulthood entails a bittersweet conflict between the desire to grow into independence and the desire for the carefree innocence and security of childhood,” she said.

    And, in general, people become more nostalgic during difficult times and in threatening circumstances, Batcho added.

    During the pandemic, as people were looking for ways to entertain themselves at home or in small groups they turned to social media for ideas, Juli Lennett, Circana’s toy industry advisor, told CNN. That helped fuel an increase in purchases for games, puzzles, collectibles, trading cards, building sets and more, she said.

    “Consumers found like-minded toy consumers and tribes formed around certain toy categories and brands. It continues to this day,” Lennett said.

    In 2021, Lego launched an entire product line designed for adults that can be found under the “Adults Welcome” section of its site. “In a world of distractions, LEGO Sets for Adults offer a focused, hands-on, mindful activity. A creative recharge. A zone of zen. A place to find your flow,” a post on Lego’s site states.

    A growing share of adults are buying toys for themselves.

    Mattel Inc.’s American Girl doll line has also seen an influx of purchases made by kidults over the past few years, “and it continues to grow in popularity,” Jamie Cygielman, the president of American Girl, told CNN.

    That started to take off in 2021 when American Girl re-released six of the original dolls the company had produced to celebrate its 35th anniversary. The dolls, priced at $150, began to sell out the first day they were listed online, said Cygielman. More than half of those purchases “were women purchasing for themselves, not for a child,” she said based on a subsequent survey American Girl conducted.

    American Girl first started selling alcohol at its first retail store café in Chicago in 1998. Now all nine of its cafés either have full liquor licenses or serve beer and wine, making it a popular destination for Gen Z and millennial customers to celebrate bachelorettes and birthdays, often with their dolls.

    “So we started really leaning into it a bit more,” she said. That meant re-releasing more dolls and doll outfits adults grew up with as well as adding more alcoholic beverages and food items that appeal to adults to its in-store café menus.

    “Any given day as you walk into our café, you’ll see tables of young adults with not a child in sight,” said Cygielman. Many of them come there to celebrate birthdays and bachelorette parties, often with their dolls sitting in clip-on chairs beside them.

    Most recently, American Girl re-released two doll outfits that were originally sold in 1999.

    TikTokers and Instagramers had a field day seeing those and rushed to post about it.

    Since American Girl creates individual stories featuring historical eras like the Colonial period or World War II to complement the dolls they sell, users on social media started posting things like, “We need an American Girl doll who went to college in 2016.”

    The TikTok account that posted that request, @inbloombyemily, received nearly 200,000 likes on her video where she described the doll’s story and curated outfits and accessories which included a Svedka bottle of strawberry lemonade vodka.

    In February, American Girl rereleased the two outfits on the dolls pictured in the middle that were originally sold in 1999. It's part of the company's efforts to attract more nostalgic adults to make purchases for themselves.

    American Girl hasn’t seized the opportunity to actually make most of the dolls the memes capture, said Cygielman.

    “It’s a sincere form of flattery, but we don’t necessarily want to author it ourselves,” she said. “We’re still laser-focused on our core customer, which is that young girl and her caregiver gift giver.”

    As for the kidult trend, there are some signs that it could slow, Lennett said.

    “As consumers have less money in their wallets due to macroeconomic conditions, they are spending less on discretionary categories like toys,” she said. “If the conditions continue, we can expect a pullback in toy spending for adults.”

    But Batcho, the psychologist, notes that nostalgia can be healthy in hard times.

    “Nostalgic memories remind people of better times and can encourage them to seek solutions and move toward a more optimistic future,” she said. “Nostalgia has also been found to increase a sense of meaning and purpose in life. By strengthening social connectedness and feelings of belonging, nostalgia counteracts loneliness.”

    Even though the darkest days of the pandemic are, for the most part, in the rearview mirror there’s still “a nostalgic longing for the security and stability of pre-pandemic life,” Batcho said.

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  • Bangladesh’s worst ever dengue outbreak a ‘canary in the coal mine’ for climate crisis, WHO expert warns | CNN

    Bangladesh’s worst ever dengue outbreak a ‘canary in the coal mine’ for climate crisis, WHO expert warns | CNN



    CNN
     — 

    Bangladesh is battling its worst dengue outbreak on record, with more than 600 people killed and 135,000 cases reported since April, the World Health Organization said Wednesday, as one of its experts blamed the climate crisis and El Nino weather pattern for driving the surge.

    The country’s health care system is straining under the influx of sick people, and local media have reported hospitals are facing a shortage of beds and staff to care for patients. There were almost 10,000 hospitalizations on August 12 alone, according to WHO.

    WHO director-general Tedros Adhanom Ghebreyesus said in a news briefing Wednesday that of the 650 people who have died since the outbreak began in April, 300 were reported in August.

    While dengue fever is endemic in Bangladesh, with infections typically peaking during the monsoon season, this year the uptick in cases started much earlier – toward the end of April.

    Tedros said WHO is supporting the Bangladeshi government and authorities “to strengthen surveillance, lab capacity, clinical management, vector control, risk communication and community engagement,” during the outbreak.

    “We have trained doctors and deployed experts on the ground. We have also provided supplies to test for dengue and support care for patients,” he said.

    A viral infection, dengue causes flu-like symptoms, including piercing headaches, muscle and joint pains, fever and full body rashes. It is transmitted to humans through the bite of an infected Aedes mosquito and there is no specific treatment for the disease.

    Dengue is endemic in more than 100 countries and every year, 100 million to 400 million people become infected, according to WHO.

    All 64 districts across Bangladesh have been affected by the outbreak but the capital Dhaka – home to more than 20 million people – has been the worst-hit city, according to WHO. Though cases there are starting to stabilize.

    “Cases are starting to decline in the capital Dhaka but are increasing in other parts of the country,” Tedros said.

    Dhaka is one of the most densely populated cities in the world and rapid unplanned urbanization has exacerbated outbreaks.

    “There is a water supply problem in Dhaka, so people keep water in buckets and plastic containers in their bathrooms or elsewhere in the home. Mosquitoes can live there all year round,” Kabirul Bashar, professor at Jahangirnagar University’s Zoology department, wrote in the Lancet journal last month.

    “Our waste management system is not well planned. Garbage piles up on the street; you see a lot of little plastic containers with pools of water in them. We also have multi-story buildings with car parks in the basements. People wash their vehicles down there, which is ideal for the mosquitoes.”

    To cope with the onslaught of infections, Bangladesh has repurposed six Covid-19 hospitals to care for dengue patients and requested help from WHO to help detect and manage cases earlier, WHO said.

    Climate crisis spreading and amplifying outbreaks

    The record number of dengue cases and deaths in Bangladesh comes as the country has seen an “unusual episodic amount of rainfall, combined with high temperatures and high humidity, which have resulted in an increased mosquito population throughout Bangladesh,” WHO said in August.

    Those warm, wet conditions make the perfect breeding ground for disease-carrying mosquitoes and as the planet continues to rapidly heat due to the burning of fossil fuels, outbreaks will become more common in new regions of the world.

    The global number of dengue cases has already increased eight-fold in the past two decades, according to WHO.

    “In 2000, we had about half a million cases and … in 2022 we recorded over 4.2 million,” said Raman Velayudhan, WHO’s head of the global program on control of neglected tropical diseases in July.

    As the climate crisis worsens, mosquito-borne diseases like dengue, Zika, chikungunya and yellow fever will likely continue to spread and have an ever greater impact on human health.

    “We are seeing more and more countries experiencing the heavy burden of these diseases,” said Abdi Mahamud, WHO’s alert and response director in the health emergencies program.

    Mahamud said the climate crisis and this year’s El Nino weather pattern – which brings warmer, wetter weather to parts of the world – are worsening the problem.

    This year, dengue has hit South America severely with Peru grappling with its worst outbreak on record. Cases in Florida prompted authorities to put several counties on alert. In Asia, a spike in cases has hit Sri Lanka, Thailand and Malaysia, among other nations. And countries in sub-Sarahan Africa, like Chad, have also reported outbreaks.

    Calling these outbreaks a “canary in the coalmine of the climate crisis,” Mahamud said “global solidarity” and support is needed to deal with the worsening epidemic.

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  • Fact check: The first Republican presidential debate of the 2024 election | CNN Politics

    Fact check: The first Republican presidential debate of the 2024 election | CNN Politics



    CNN
     — 

    Republican presidential candidates delivered a smattering of false and misleading claims at the first debate of the 2024 election – though none of the eight candidates on stage in Milwaukee delivered anything close to the bombardment of false statements that typically characterized the debate performances of former President Donald Trump, the Republican front-runner who skipped the Wednesday event.

    Sen. Tim Scott of South Carolina inaccurately described the state of the economy in early 2021 and repeated a long-ago-debunked false claim about the Biden-era Justice Department. Former New Jersey Gov. Chris Christie misstated the sentence attached to a gun law relevant to the investigation into the president’s son Hunter Biden. Florida Gov. Ron DeSantis misled about his handling of the Covid-19 pandemic, omitting mention of his early pandemic restrictions.

    Below is a fact check of those claims and various others from the debate, some of which left out key context. In addition, below is a brief fact check of some of Trump’s claims from a pre-taped interview he did with Tucker Carlson, which was posted online shortly before the debate aired. Trump made a variety of statements that were not true.

    DeSantis and the pandemic

    DeSantis criticized the federal government for its handling of the Covid-19 pandemic, claiming it had locked down the economy, and then said: “In Florida, we led the country out of lockdown, and we kept our state free and open.”

    Facts First: DeSantis’s claim is misleading at best. Before he became a vocal opponent of pandemic restrictions, DeSantis imposed significant restrictions on individuals, businesses and other entities in Florida in March 2020 and April 2020; some of them extended months later into 2020. He did then open up the state, with a gradual phased approach, but he did not keep it open from the start.

    DeSantis received criticism in March 2020 for what some critics perceived as a lax approach to the pandemic, which intensified as Florida beaches were packed during Spring Break. But that month and the month following, DeSantis issued a series of major restrictions. For example, DeSantis:

    • Closed Florida’s schools, first with a short-term closure in March 2020 and then, in April 2020, with a shutdown through the end of the school year. (In June 2020, he announced a plan for schools to reopen for the next school year that began in August. By October 2020, he was publicly denouncing school closures, calling them a major mistake and saying all the information hadn’t been available that March.)
    • On March 14, 2020, announced a ban on most visits to nursing homes. (He lifted the ban in September 2020.)
    • On March 17, 2020, ordered bars and nightclubs to close for 30 days and restaurants to operate at half-capacity. (He later approved a phased reopening plan that took effect in May 2020, then issued an order in September 2020 allowing these establishments to operate at full capacity.)
    • On March 17, 2020, ordered gatherings on public beaches to be limited to a maximum of 10 people staying at least six feet apart, then, three days later, ordered a shutdown of public beaches in two populous counties, Broward and Palm Beach. (He permitted those counties’ beaches to reopen by the last half of May.)
    • On March 20, 2020, prohibited “any medically unnecessary, non-urgent or non-emergency” medical procedures. (The prohibition was lifted in early May 2020.)
    • On March 23, 2020, ordered that anyone flying to Florida from an area with “substantial community spread” of the virus, “to include the New York Tri-State Area (Connecticut, New Jersey and New York),” isolate or quarantine for 14 days or the duration of their stay in Florida, whichever was shorter, or face possible jail time or a fine. Later that week, he added Louisiana to the list. (He lifted the Louisiana restriction in June 2020 and the rest in August 2020.)
    • On April 3, 2020, imposed a statewide stay-home order that temporarily required people in Florida to “limit their movements and personal interactions outside of their home to only those necessary to obtain or provide essential services or conduct essential activities.” (Beginning in May 2020, the state switched to a phased reopening plan that, for months, included major restrictions on the operations of businesses and other entities; DeSantis described it at the time as a “very slow and methodical approach” to reopening.)

    -From CNN’s Daniel Dale

    Nikki Haley, the former South Carolina governor and US ambassador to the United Nations, said: “Donald Trump added $8 trillion to our debt, and our kids are never going to forgive us for this.”

    Facts First: Haley’s figure is accurate. The total public debt stood at about $19.9 trillion on the day Trump took office in 2017 and then increased by about $7.8 trillion over Trump’s four years, to about $27.8 trillion on the day he left office in 2021.

    It’s worth noting, however, that the increase in the debt during any president’s tenure is not the fault of that president alone. A significant amount of spending under any president is the result of decisions made by their predecessors – such as the creation of Social Security, Medicare and Medicaid decades ago – and by circumstances out of a president’s control, notably including the global Covid-19 pandemic under Trump; the debt spiked in 2020 after Trump approved trillions in emergency pandemic relief spending that Congress had passed with overwhelming bipartisan support.

    Still, Trump did choose to approve that spending. And his 2017 tax cuts, unanimously opposed by congressional Democrats, were another major contributor to the debt spike.

    -From CNN’s Daniel Dale and Katie Lobosco

    North Dakota Gov. Doug Burgum claimed that Biden’s signature climate bill costs $1.2 trillion dollars and is “just subsidizing China.”

    Facts First: This claim needs context. The clean energy pieces of the Inflation Reduction Act – Democrats’ climate bill – passed with an initial price tag of nearly $370 billion. However, since that bill is made up of tax incentives, that price tag could go up depending on how many consumers take advantage of tax credits to buy electric vehicles and put solar panels on their homes, and how many businesses use the subsidies to install new utility scale wind and solar in the United States.

    Burgum’s figure comes from a Goldman Sachs report, which estimated the IRA could provide $1.2 trillion in clean energy tax incentives by 2032 – about a decade from now.

    On Burgum’s claim that Biden’s clean energy agenda will be a boon to China, the IRA was specifically written to move the manufacturing supply chain for clean energy technology like solar panels and EV batteries away from China and to the United States.

    In the year since it was passed, the IRA has spurred 83 new or expanded manufacturing facilities in the US, and close to 30,000 new clean energy manufacturing jobs, according to a tally from trade group American Clean Power.

    -From CNN’s Ella Nilsen

    With the economy as one of the main topics on the forefront of voters’ minds, Scott aimed to make a case for Republican policies, misleadingly suggesting they left the US economy in record shape before Biden took office.

    “There is no doubt that during the Trump administration, when we were dealing with the COVID virus, we spent more money,” Scott said. “But here’s what happened at the end of our time in the majority: we had low unemployment, record low unemployment, 3.5% for the majority of the population, and a 70-year low for women. African Americans, Hispanics, and Asians had an all-time low.”

    Facts First: This is false. Scott’s claims don’t accurately reflect the state of the US economy at the end of the Republican majority in the Senate. And in some cases, his exaggerations echo what Trump himself frequently touted about the economy under his leadership.

    By the time Trump left office and the Republicans lost the Senate majority in January 2021, US unemployment was not at a record low. The US unemployment rate dropped to a seasonally adjusted rate of 3.5% in September 2019, the country’s lowest in 50 years. While it hovered around that level for five months, Scott’s assertion ignores the coronavirus pandemic-induced economic destruction that followed. In April 2020, the unemployment rate spiked to 14.7% — the highest level since monthly records began in 1948. As of December 2020, the unemployment rate was at 6.7%.

    Nor was the unemployment rate for women at a 70-year low by the end of Trump’s time in office. It reached a 66-year low during certain months of 2019, at 3.4% in April and 3.6% in August, but by December 2020, unemployment for women was at 6.7%.

    The unemployment rates for African Americans, Hispanics, and Asians were also not at all-time lows at the end of 2020, but they did reach record lows during Trump’s tenure as president.

    -From CNN’s Tara Subramaniam

    Scott said that the Justice Department under President Joe Biden is targeting “parents that show up at school board meetings. They are called, under this DOJ, they’re called domestic terrorists.”

    Facts First: It is false that the Justice Department referred to parents as domestic terrorists. The claim has been debunked several times – during the uproar at school boards over Covid-19 restrictions and anti-racism curriculums; after Kevin McCarthy claimed Republicans would investigate Merrick Garland with a majority in the House; and even by a federal judge. The Justice Department never called parents terrorists for attending or wanting to attend school board meetings.

    The claim stems from a 2021 letter from The National School Boards Associations asking the Justice Department to “deal with” the uptick in threats against education officials and saying that “acts of malice, violence, and threats against public school officials” could be classified as “the equivalent to a form of domestic terrorism and hate crimes.” In response, Garland released a memo encouraging federal and local authorities to work together against the harassment campaigns levied at schools, but never endorsed the “domestic terrorism” notion.

    A federal judge even threw out a lawsuit over the accusation, ruling that Garland’s memo did little more than announce a “series of measures” that directed federal authorities to address increasing threats targeting school board members, teachers and other school employees.

    -From CNN’s Hannah Rabinowitz

    Haley, the former ambassador to the United Nations and governor of South Carolina, said the US is spending “less than three and a half percent of our defense budget” on Ukraine aid, and that in terms of financial aid relative to GDP, “11 of the European countries have given more than the US.”

    Facts First: This is partly true. Haley’s claim regarding the US aid to Ukraine compared to the total defense budget is slightly under the actual percentage, but it is accurate that 11 European countries have given more aid to Ukraine as a percentage of their total GDP than the US.

    As of August 14, the US has committed more than $43 billion in military aid to Ukraine since the beginning of the war in Ukraine, according to the Defense Department. In comparison, the Fiscal Year 2023 defense budget was $858 billion – making aid to Ukraine just over 5% of the total US defense budget.

    As of May 2023, according to a Council of Foreign Relations tracker, 11 countries were providing a higher share in aid to Ukraine relative to their GDP than the US – led by Estonia, Latvia, Lithuania, and Poland.

    -From CNN’s Haley Britzky

    Former Vice President Mike Pence said Wednesday that the Trump administration “spent funding to backfill on the military cuts of the Obama administration.”

    Facts First: This is misleading. While military spending decreased under the Obama administration, it was largely due to the 2011 Budget Control Act, which received Republican support and resulted in automatic spending cuts to the defense budget.

    Mike Pence, a senator at the time, voted in favor of the Budget Control Act.

    -From CNN’s Haley Britzky

    Christie said President Biden’s son Hunter Biden was “facing a 10-year mandatory minimum” for lying on a federal form when he purchased a gun in 2018.

    Facts First: Christie, a former federal prosecutor, clearly misstated the law. This crime can lead to a maximum prison sentence of 10 years, but it doesn’t have a 10-year mandatory minimum.

    These comments are related to the highly scrutinized Justice Department investigation into Hunter Biden, which is currently ongoing after a plea deal fell apart earlier this summer.

    As part of the now-defunct deal, Hunter Biden agreed to plead guilty to two tax misdemeanors and enter into a “diversion agreement” with prosecutors, who would drop the gun possession charge in two years if he consistently stayed out of legal trouble and passed drug tests.

    The law in question makes it a crime to purchase a firearm while using or addicted to illegal drugs. Hunter Biden has acknowledged struggling with crack cocaine addiction at the time, and admitted at a court hearing and in court papers that he violated this law by signing the form.

    The US Sentencing Commission says, “The statutory maximum penalty for the offense is ten years of imprisonment.” There isn’t a mandatory 10-year punishment, as Christie claimed.

    During his answer, Christie also criticized the Justice Department for agreeing to a deal in June where Hunter Biden could avoid prosecution on the felony gun offense. That deal was negotiated by special counsel David Weiss, who was first appointed to the Justice Department by former President Donald Trump.

    -From CNN’s Marshall Cohen

    Burgum and Scott got into a back and forth over IRS staffing with Burgum saying that the “Biden administration wanted to put 87,000 people in the IRS,” and Scott suggesting they “fire the 87,000 IRS agents.”

    Facts First: This figure needs context.

    The Inflation Reduction Act, which passed last year without any Republican votes, authorized $80 billion in new funding for the IRS to be delivered over the course of a decade.

    The 87,000 figure comes from a 2021 Treasury report that estimated the IRS could hire 86,852 full-time employees with a nearly $80 billion investment over 10 years.

    While the funding may well allow for the hiring of tens of thousands of IRS employees over time, far from all of these employees will be IRS agents conducting audits and investigations.

    Many other employees will be hired for the non-agent roles, from customer service to information technology, that make up most of the IRS workforce. And a significant number of the hires are expected to fill the vacant posts left by retirements and other attrition, not take newly created positions.

    The IRS has not said precisely how many new “agents” will be hired with the funding. But it is already clear that the total won’t approach 87,000. And it’s worth noting that the IRS may not receive all of the $80 billion after Republicans were able to claw back $20 billion of the new funding as part of a deal to address the debt ceiling made earlier this year.

    -From CNN’s Katie Lobosco

    Trump repeated a frequent claim during his interview with Carlson that streamed during the GOP debate that his retention of classified documents at Mar-a-Lago after leaving the White House was “covered” under the Presidential Records Act and that he is “allowed to do exactly that.”

    Facts First: This is false. The Presidential Records Act says the exact opposite – that the moment presidents leave office, all presidential records are to be turned over to the federal government. Keeping documents at Mar-a-Lago after his presidency concluded was in clear contravention of that law.

    According to the Presidential Records Act, “upon the conclusion of a President’s term of office, or if a President serves consecutive terms upon the conclusion of the last term, the Archivist of the United States shall assume responsibility for the custody, control, and preservation of, and access to, the Presidential records of that President.”

    The sentence makes clear that a president has no authority to keep documents after leaving the White House.

    The National Archives even released a statement refuting the notion that Trump’s retention of documents was covered by the Presidential Records Act, writing in a June news release that “the PRA requires that all records created by Presidents (and Vice-Presidents) be turned over to the National Archives and Records Administration (NARA) at the end of their administrations.”

    -From CNN’s Hannah Rabinowitz

    While discussing electric vehicles, Trump claimed that California “is in a big brownout because their grid is a disaster,” adding that the state’s ambitious electric vehicle goals won’t work with the grid in such shape.

    Facts First: Trump’s claim that California’s grid is currently in a “big brownout” and is a “disaster” isn’t true. California’s grid suffered rolling blackouts in 2020, but it has performed quite well in the face of extreme heat this summer, owing in large part to a massive influx of renewable energy including battery storage. These big batteries keep energy from wind and solar running when the wind isn’t blowing and sun isn’t shining. (Batteries are also being deployed at a rapid rate in Texas, a red state.)

    Another reason California’s grid has stayed stable this year even during extreme temperature spikes is the fact that a deluge of snow and rain this winter and spring has refilled reservoirs that generate electricity using hydropower.

    As Trump insinuated, there are real questions about how well the state’s grid will hold up as California’s drivers shift to electric vehicles by the millions by 2035 – the same year it will phase out selling new gas-powered cars. California state officials say they are preparing by adding new capacity to the grid and urging more people to charge their vehicles overnight and during times of the day when fewer people are using energy. But independent experts say the state needs to exponentially increase its clean energy while also building out huge amounts of new EV chargers to achieve its goals.

    -From CNN’s Ella Nilsen

    Trump and the border wall

    Trump claimed to Carlson, “I had the strongest border in the history of our country, and I built almost 500 miles of wall. You know, they’d like to say, ‘Oh, was it less?’ No, I built 500 miles. In fact, if you check with the authorities on the border, we built almost 500 miles of wall.”

    Facts First: This needs context. Trump and his critics are talking about different things when they use different figures for how much border wall was built during his presidency. Trump is referring to all of the wall built on the southern border during his administration, even in areas that already had some sort of barrier before. His critics are only counting the Trump-era wall that was built in parts of the border that did not have any previous barrier.

    A total of 458 miles of southern border wall was built under Trump, according to a federal report written two days after Trump left office and obtained by CNN’s Priscilla Alvarez. That is 52 miles of “primary” wall built where no barriers previously existed, plus 33 miles of “secondary” wall that was built in spots where no barriers previously existed, plus another 373 miles of primary and secondary wall that was built to replace previous barriers the federal government says had become “dilapidated and/or outdated.”

    Some of Trump’s rival candidates, such DeSantis and Christie, have used figures around 50 miles while criticizing Trump for failing to finish the wall – counting only the primary wall built where no barriers previously existed.

    While some Trump critics have scoffed at the replacement wall, the Trump-era construction was generally much more formidable than the older barriers it replaced, which were often designed to deter vehicles rather than people on foot. Washington Post reporter Nick Miroff tweeted in 2020: “As someone who has spent a lot of time lately in the shadow of the border wall, I need to puncture this notion that ‘replacement’ sections are ‘not new.’ There is really no comparison between vehicle barriers made from old rail ties and 30-foot bollards.”

    Ideally, both Trump and his opponents would be clearer about what they are talking about: Trump that he is including replacement barriers, his opponents that they are excluding those barriers.

    -From CNN’s Daniel Dale

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  • Meta’s Threads is temporarily blocking searches about Covid-19 | CNN Business

    Meta’s Threads is temporarily blocking searches about Covid-19 | CNN Business



    CNN
     — 

    Threads, the much-hyped social media app from Facebook-parent Meta, is taking heat for blocking searches for “coronavirus,” “Covid,” and other pandemic-related queries.

    The tech giant’s decision to block coronavirus-related searches on its service comes as the United States deals with a recent uptick in Covid-19 hospitalizations, per CDC data, and more than three years into the global pandemic.

    News of Threads blocking searches related to the coronavirus was first reported by The Washington Post.

    A Meta spokesperson told CNN that the company just began rolling out keyword search for Threads to additional countries last week.

    “The search functionality temporarily doesn’t provide results for keywords that may show potentially sensitive content,” the statement added. “People will be able to search for keywords such as ‘COVID’ in future updates once we are confident in the quality of the results.” 

    As of Monday, searches on the Threads app conducted by CNN for “coronavirus,” “Covid” and “Covid-19” yielded a blank page with the text: “No results.” Searches for “vaccine” also prompted no results. Typing any of these queries into the Threads app does, however, offer a link directing users to the CDC’s website on Covid-19 or vaccinations, depending on the search.

    Meta did not disclose what other keyword searches currently yield no results.

    Meta’s Facebook and other social media platforms faced controversy in the early part of the pandemic for the apparent spread of Covid-19-related misinformation online.

    Meta officially launched Threads in early July, and the app quickly garnered more than 100 million sign-ups in its first week on the heels of months of chaos at Twitter, which is now known as X. But much of the buzz faded somewhat in the weeks that followed as users realized the bare-bones platform still lacked many of the features that made X popular with users.

    Threads released its much-requested web version late last month, and its keyword search about a week ago. But the current limitations around its search function highlights how the platform still has some kinks to work through before it can fully replace the real-time search and engagement experience that social media users have historically relied on with X.

    –CNN’s Clare Duffy contributed to this report.

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  • Watchdog agency increases its pandemic unemployment benefits fraud estimate to as much as $135 billion | CNN Politics

    Watchdog agency increases its pandemic unemployment benefits fraud estimate to as much as $135 billion | CNN Politics


    Washington
    CNN
     — 

    As much as $135 billion in fraudulent Covid-19 pandemic unemployment insurance claims were likely paid out, according to a report released Tuesday by the US Government Accountability Office.

    The whopping figure, which equates to as much as 15% of total unemployment benefits distributed during the pandemic, is a notable bump up from the $60 billion the watchdog agency had previously estimated in January.

    In comments on a draft of the GAO report, the Department of Labor said the office is likely overestimating the actual amount of fraud. However, the department’s Office of Inspector General in February said in testimony before a House committee that at least $191 billion in pandemic unemployment benefits payments could have been improper, with “a significant portion attributable to fraud.”

    The GAO pushed back on the department’s assertions in its report and stood by the methodology used.

    “Given that not all potential fraud will be investigated and adjudicated through judicial or other systems, the full extent of UI fraud during the pandemic will likely never be known with certainty,” the GAO report said. “Therefore, it is appropriate to rely on estimates, such as ours, to make more comprehensive conclusions about the extent of fraud in the UI programs during the pandemic.”

    The findings released on Tuesday shed light on the numerous schemes to steal money from a range of hastily implemented pandemic relief programs, which have drawn the attention of congressional lawmakers and prompted legislative action. Last year, President Joe Biden signed two bipartisan bills into law aimed at holding individuals who commit fraud under pandemic relief programs accountable.

    “My message to those cheats out there is this: You can’t hide. We’re going to find you. We’re going to make you pay back what you stole and hold you accountable under the law,” the president said at the time.

    The House of Representatives also passed a bill in May that would help recover fraudulent unemployment insurance benefits paid out during the pandemic. The bill, however, has not been brought to a vote in the Senate.

    Fraud within the nation’s unemployment system skyrocketed after Congress enacted a historic expansion of the program in March 2020. State unemployment agencies were overwhelmed with record numbers of claims and relaxed some requirements in an effort to get the money out the door quickly to those who had lost their jobs.

    But the enhanced payments and lax controls quickly attracted criminals from around the world. States and Congress subsequently tightened their verification requirements in an attempt to combat the fraud, particularly in the Pandemic Unemployment Assistance program, which allowed freelancers, gig workers and others to collect benefits for the first time.

    More than $888 billion in federal and state unemployment benefits were paid from the end of March 2020 through early September 2021, when all the pandemic enhancements ended nationwide, according to the Labor Department Office of Inspector General.

    The GAO report said the “unprecedented demand for benefits and need to quickly implement the new programs increased the risk of fraud.”

    Other pandemic relief programs were also the target of criminals. The GAO in May flagged 3.7 million recipients of Small Business Administration funds as having “warning signs consistent with potential fraud.” The SBA doled out $1 trillion to help small businesses during the pandemic through measures including the Paycheck Protection Program and Covid-19 Economic Injury Disaster Loan program. More than 10 million small businesses were assisted.

    Some of the fraudulent claims have been recouped. States identified $5.3 billion in fraudulent unemployment benefits overpayments and has recovered $1.2 billion, according to the GAO.

    A Justice Department spokesperson told CNN on Tuesday that as of August 30, the department has charged more than 3,000 people for pandemic related fraud.

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  • America’s child care problem is about to get a lot worse. Here’s why | CNN Politics

    America’s child care problem is about to get a lot worse. Here’s why | CNN Politics



    CNN
     — 

    Sarah Morgan was looking forward to enrolling her 1-year-old son Lucas at the Skagit Valley Family YMCA’s early learning center in Anacortes, Washington, this fall.

    Her older son Jameson, 5, had a wonderful experience there, learning his letters, numbers and colors, as well as social skills – all of which smoothed his transition to kindergarten this year.

    But in late August, Morgan found out that the YMCA was closing the Anacortes center.

    Like many child care providers across the nation, the YMCA has had to rethink its operations with the looming expiration of a $24 billion federal Covid-19 pandemic support program that kept many centers afloat over the past two years. The nonprofit, which received $271,000 for its early learning programs, opted to close the Anacortes location, which served 21 families, so it could funnel its resources into its three remaining centers, said its CEO Dean Snider.

    That decision has left the Morgan family scrambling to find alternate arrangements for Lucas. Child care is limited on Anacortes, an island in the northwest part of the state. The YMCA’s closest remaining centers are a 40-minute drive away, which doesn’t fit the work schedules of either her or her husband, Travus. And the nannies they interviewed asked for hourly rates that are close to what Morgan earns.

    So Morgan plans to place Lucas with an in-home provider, though she worries he won’t have the same educational opportunities that his older brother had at the YMCA.

    “It’s really sad that my next one won’t have that type of experience,” said Morgan, a social worker employed by the state. “It’s just really been devastating.”

    Nationwide, more than 70,000 child care programs are projected to close, and about 3.2 million children could lose their spots due to the end of the child care stabilization grant program on September 30, according to an analysis by The Century Foundation.

    The historic federal investment, which was part of the $1.9 trillion American Rescue Plan Act that Democrats passed in March 2021, supported more than 220,000 child care programs, affecting as many as 9.6 million children, according to the federal Administration for Children & Families. It reached more than 8 in 10 licensed child care centers, helping them hold onto workers by offering bonuses and raising wages, cover their rent, mortgage and utilities, buy personal protective equipment and other supplies, and provide mental health support.

    “We have not spent that much money on child care previously in the US,” said Julie Kashen, women’s economic justice director at The Century Foundation. “What we learned was that it worked. It kept programs open. It helped address the staffing shortages. It kept children safe and nurtured. It kept parents working.”

    Child care in America has long had issues: The costs are steep for both providers and parents, leaving it both in short supply and unaffordable for many families. Last year, the average annual price nationwide was nearly $11,000, according to Child Care Aware of America, though the rates can be much higher depending on the location.

    At the same time, the pay is low, making it hard for workers to commit to the industry and for centers to hold onto their staff. Child care workers typically earned $13.71 an hour, or $28,520 a year, in 2022, according to the Bureau of Labor Statistics. Employment remains lower than it was prior to the pandemic.

    For Carla Smith, the stabilization grants were a “miracle.”

    Smith, who founded Cornerstone Academy in Arlington, Texas, 17 years ago while nursing her newborn son, used $1.1 million in stabilization grants and other federal relief funding to rebuild after enrollment plunged in the first year of the pandemic. She was able to hire more employees and boost the wages of her teachers and administrative staff to as much as $25 an hour. That’s about double what most were earning before and enticed them to stay at the academy.

    Carla Smith founded and operates Cornerstone Academy in Arlington, Texas.

    “It kept the day care open. It kept day care workers employed, and it kept families employed,” said Smith, who now cares for 50 children ages 6 weeks to 5 years.

    Now that she won’t receive any additional federal stabilization funds, Smith is worried she might have to close her doors next summer if the church that houses the center doesn’t step in to help. She just raised tuition by up to $200 a month for most children and $600 a month for infants, prompting one family to leave and several others to pull out of the after-school program. She and the assistant director have taken five-figure pay cuts, she laid off one worker and she reduced the hours of the others.

    “The next layoff will be myself,” she said, noting that she’s already looking for other jobs so she can keep the academy operating.

    Without the stabilization grants, the Chinese-American Planning Council in New York City will have a tougher time hiring and retaining staffers who care for 180 children at six sites, said Mary Cheng, the director of childhood development services. The nearly $600,000 in funding allowed her to provide bonuses of up to $2,500 every six months between July 2021 and this summer, as well as temporarily increase the pay of the after-school staff by a dollar or two. In addition, she used the funds to buy air purifiers and cleaning supplies, as well as provide mental health support for the children and staff.

    Now, she’s looking for several teachers and assistant teachers, as well as an education director for one of the sites. But it’s hard to attract candidates when the pay she’s offering – even for the director role – is less than an entry-level public school teacher.

    Already, because of the staffing shortage, she’s had to close one classroom in a public housing development, turning away the parents of 12 children.

    But the council may have to undertake some more fundamental changes to its child care program, which has been funded by the city since it started in the 1970s. Cheng is looking to raise $500,000 in donations and grants for its preschool and after-school programs this year to cover the shortfall in federal support, far more than the $15,000 it has raised annually in the past.

    The Chinese-American Planning Council used its pandemic stabilization grants to retain and hire staff, as well as buy cleaning supplies and provide mental health services.

    And it may have to start accepting children whose parents can pay tuition for the first time.

    “Now I have to think about ‘How do I make a profit?,” said Cheng, who attended the child care program when she was little. “You have to sustain the programming that has to happen for these families. You have to think about a profit in that way because when things hit the fan like this, you’ve got to figure out ‘What can I do to make ends meet?’”

    A group of Democratic and independent senators and representatives are pushing to extend federal assistance for child care beyond September 30. They introduced the Child Care Stabilization Act, which would provide $16 billion each year for the next five years.

    “There was a child care crisis even before the pandemic – and failing to extend these critical investments from the American Rescue Plan will push child care even further out of reach for millions of families and jeopardize our strong economic recovery,” Sen. Patty Murray of Washington said in a statement. “This is an urgent economic priority at every level: Child care is what allows parents to go to work, businesses to hire workers, and it’s an investment in our kids’ futures. The child care industry holds up every sector of our economy – and Congress must act now.”

    Meanwhile, a bipartisan bill introduced in the House would enhance three existing tax credits – the Child and Dependent Care Tax Credit, the Employer-Provided Child Care Credit and the Dependent Care Assistance Program – to help make child care more affordable for families and to support employers in sharing the cost of care.

    However, getting any additional funding through Congress will be difficult. House GOP hardliners are determined to cut spending in the fiscal 2024 government funding bill, making it more likely the government could shut down on October 1.

    Vanessa Quarles is among the many child care providers who hope that Congress renews its support for the industry.

    Quarles, who runs Bridges Transitional Preschool & Childcare in Evansville, Indiana, cannot take in more children until she can find more workers. But she can only afford to pay up to $14 an hour, which is barely a livable wage in the area, she said. Quarles raised tuition in February and stopped offering lunch, but she fears she’ll drive away parents if she asks them to shell out any more.

    Vanessa Quarles, a child care provider, has found it hard to hire workers even though she advertises widely.

    If she received federal funding, she would be able to provide raises and bonuses to attract more employees.

    “A lot of people are having a hard time accepting the pay range of child care workers,” said Quarles, who did not receive any stabilization grants. “That’s one reason why we are not fully functioning.”

    At least 17 states invested their own money into child care this year, according to a tally by Child Care Aware. These include historic investments by Alabama, Alaska, Maine, Massachusetts, Minnesota, Vermont and Washington.

    Washington funneled more than $400 million this year into early learning, the largest investment in state history, according to Child Care Aware. It builds on the Fair Start for Kids Act, which state lawmakers passed in 2021. The effort increased the number of households eligible for assistance by raising income eligibility limits – a family of four earning as much as $5,600 a month in 2023 qualifies for monthly copays of only $165. It also bumped up the rates paid to providers for serving state-subsidized families.

    But more needs to be done to keep providers afloat, said Ryan Pricco, director of policy and advocacy at Child Care Aware of Washington. Currently, reimbursement rates are determined by a market survey, but that reflects what parents can afford, not the true cost of care.

    “Until we switch our subsidy system, and really our whole financing system, over to a cost of care model and reimburse programs that way, they’re going to continue to struggle to keep up with competitors and other low-income industries,” he said.

    The Skagit Valley Family YMCA had to close one of its early learning centers after the federal stabilization program expired.

    While the Skagit Valley Family YMCA needed the stabilization grants to bolster its child care workforce, those infusions alone are not enough to solve its financial imbalance, Snider said. Revenue from families paying full price and subsidized rates only cover the cost of staffing, not rent, food for the children and other expenses. The agency has racked up six-figure losses across its early learning centers so far this year, which is “obviously unsustainable,” Snider said.

    “Early learning is not a viable proposition right now,” he continued. “Everyone calls it necessary, but no one’s willing to put the resources in yet to make it possible.”

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  • Trump and DeSantis trade shots in New Hampshire showdown | CNN Politics

    Trump and DeSantis trade shots in New Hampshire showdown | CNN Politics



    CNN
     — 

    Florida Gov. Ron DeSantis described former President Donald Trump as having over-promised and under-delivered on Tuesday, vowing in New Hampshire to “break the swamp” in Washington while faulting Trump for failing to deliver on his 2016 campaign promises to “drain” it.

    “If I tell you I’m going to do something, I’m not just saying that for an election,” DeSantis said in one of his sharpest attacks on the former president yet.

    Trump, meanwhile, mocked the size of DeSantis’ town hall crowds, telling attendees at a luncheon in Concord that “nobody showed up” to the Florida governor’s event a 40-minute drive south in Hollis.

    The two top-polling contenders for the GOP’s 2024 nomination circled each other Tuesday in New Hampshire, trading shots as they crisscrossed the state that hosts the first primary – after Iowa’s caucuses – and is a crucial momentum-builder.

    Their exchanges offered a preview of the months to come, with the Republican field having taken shape in recent weeks and the party’s first presidential debate less than two months away.

    Trump was blunt about why he was targeting DeSantis, rather than other GOP 2024 rivals, such as his former vice president, Mike Pence, or his former United Nations ambassador, Nikki Haley.

    “Somebody said, ‘How come you only attack him?’” Trump told the crowd in Concord. “I said, ‘Cause he’s in second place.’”

    “‘Well, why don’t you attack others?’” Trump said, repeating the question he said he was asked. “Because they’re not in second place. But soon, I don’t think he’ll be in second place, so I’ll be attacking somebody else.”

    The former president even praised two other GOP contenders, entrepreneur Vivek Ramaswamy, who he said is “actually a pretty good guy” after Ramaswamy said he would pardon Trump, and South Carolina Sen. Tim Scott, who he said “happens to be a very nice guy, actually.”

    Harping on early-state polls that show Trump with a lead in the GOP’s 2024 primary, Trump focused his attacks on DeSantis over his response to the Covid-19 pandemic in Florida and his past support for privatizing Social Security and Medicare.

    Trump argued that during the height of the coronavirus pandemic, DeSantis wanted “everything closed” in Florida and gave “very threatening speeches – you know, thinks he’s a tough guy.”

    He said DeSantis “loved Fauci,” referring to the government’s former top infectious disease expert, who was a central figure in the Trump administration’s response to the pandemic and recently retired during President Joe Biden’s administration.

    Trump’s remarks came shortly after DeSantis had fielded a voter’s question about Trump at a town hall in Hollis.

    A voter told DeSantis “most of us in this room voted to drain the swamp twice” and asked why he’s the one to “get it done this time as opposed to the other choice.”

    “I remember these rallies in 2016. It was exciting. ‘Drain the swamp.’ I also remember ‘Lock her up, lock her up,’ right? And then two weeks after the election, ‘Ah no, forget about it. Forget I ever said that.’ No, no, no. One thing you’ll get from me, if I tell you I’m going to do something, I’m not just saying that for an election,” DeSantis said.

    He said he doesn’t make promises he can’t follow through on, even if they might help him “marginally politically.” DeSantis also said just draining the swamp is not effective enough. Instead, he said he wants to “break” it.

    It was a riff on one of Trump’s signature 2016 campaign lines, and a suggestion that the former president had not delivered on his lofty promises to remake Washington.

    “The idea of draining the swamp, in some respects, I think it misses it a little bit,” DeSantis said. “We didn’t drain it. It’s worse today than it’s ever been by far. And that’s a sad testament to the state of affairs of our country. But even if you’re successful at draining it, the next guy can just refill it. So, I want to break the swamp. That’s really what we need to do.”

    The Florida governor said he would “drop the hammer” on some federal agencies, including the Justice Department, the Federal Bureau of Investigation and the Internal Revenue Service, and “end the weaponization of government.”

    “All of these agencies are going to be turned inside and out,” DeSantis said.

    His promise of a more aggressive approach than Trump’s ignores the potential legal hurdles he could encounter if elected next November. In Florida, more than a dozen legal battles testing the constitutionality of many of the victories DeSantis has touted on the campaign trail are ongoing. Critics say DeSantis has built his governorship around enacting laws that appeal to his conservative base but that, as a Harvard-trained lawyer, he knows are unconstitutional and not likely to take effect.

    The Florida governor’s remarks in New Hampshire came the day after he had taken aim at another signature Trump 2016 campaign pledge: DeSantis said that “not nearly enough” of the wall Trump had promised on the United States-Mexico border had been built.

    “For us, it’s going to be a national emergency on day one. This is going to be mobilizing all available assets on day one. We have a plan for all the different levers of authority that we have to be able to bring this to bear,” DeSantis said at the Rio Grande River on the U.S. Mexico Border in Maverick County, Texas, on Monday.

    In an effort to position himself to Trump’s political right on immigration enforcement, DeSantis also said he would be “more aggressive in terms of our plan than anything he did in empowering local officials to enforce immigration law.”

    Trump fired back on the issue later Tuesday in his second New Hampshire stop as he mingled with voters in Manchester at the opening of his campaign headquarters there, saying that DeSantis was promising to carry out policies that Trump had already enacted as president.

    “I saw DeSantis yesterday, he got up and said exactly what I was doing,” with his border and immigration policies, Trump said.

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  • How charging drivers to go downtown would transform American cities | CNN Business

    How charging drivers to go downtown would transform American cities | CNN Business


    New York
    CNN
     — 

    President Joe Biden’s administration is set to allow New York City to move forward with a landmark program that will toll vehicles entering Lower Manhattan, after a public review period ends Monday.

    The toll is formally known as the Central Business District Tolling Program — but it’s commonly called “congestion pricing.”

    In practice it works like any other toll, but because it specifically charges people to drive in the traffic-choked area below 60th street in Manhattan, it would be the first program of its kind in the United States.

    Proposals range from charging vehicles $9 to $23 during peak hours, and it’s set to go into effect next spring.

    The plan had been delayed for years, but it cleared a milestone last month when the Federal Highway Administration signed off on the release of an environmental assessment. The public has until Monday to review the report, and the federal government is widely expected to approve it shortly after.

    From there, the New York Metropolitan Transportation Authority (MTA) can finalize toll rates, as well as discounts and exemptions for certain drivers.

    New York City is still clawing out of from the devastating impact of the Covid-19 pandemic. Congestion pricing advocates say it’s a crucial piece of the city’s recovery and a way to re-imagine the city for the future.

    “This program is critical to New York City’s long-term success,” New York Gov. Kathy Hochul said last month.

    The plan would also mark the culmination of more than a half-century of efforts to implement congestion pricing in New York City. Despite support from several New York City mayors and state governors, car and truck owners in outer boroughs and the suburbs helped defeat proposals.

    In 2007 Mayor Michael Bloomberg called congestion “the elephant in the room” when proposing a toll program, which state lawmakers killed. A decade later, Gov. Andrew Cuomo — who had long resisted congestion pricing — said it was “an idea whose time has come” and declared a subway state of emergency after increased delays and a derailment that injured dozens. Two years later, the state gave the MTA approval to design a congestion pricing program.

    Ultimately, it was the need to improve New York City’s public transit that became the rallying cry for congestion pricing.

    Each day 700,000 cars, taxis and trucks pour into Lower Manhattan, one of the busiest areas in the world with some of the worst gridlock in the United States.

    Car travel at just 7.1 mph on average in the congestion price zone, and it’s a downward trend. Public bus speeds have also declined 28% since 2010. New Yorkers lose 117 hours on average each year sitting in traffic, costing them nearly $2,000 in lost productivity and other costs, according to one estimate.

    The toll is designed to reduce the number of vehicles entering the congestion zone by at least 10% every day and slash the number of miles cars travel within the zone by 5%.

    Congestion comes with physical and societal costs, too: more accidents, carbon emissions and pollution happen as belching, honking cars take up space that could be optimized for pedestrians and outdoor dining.

    Proponents also note it will improve public transit, an essential part of New York life. About 75% of trips downtown are via public transit.

    But public-transit ridership is 35% to 45% lower compared to pre-pandemic levels. The MTA says congestion fees will generate a critical source of revenue to fund $15 billion in future investments to modernize the city’s 100-year-old public transit system.

    The improvements, like new subway cars and electric signals, are crucial to draw new riders and improve speed and accessibility — especially for low-income and minority residents, who are least likely to own cars, say plan advocates.

    New York City is “dependent on public transit,” said Kate Slevin, the executive vice president of the Regional Plan Association, an urban planning and policy group. “We’re relying on that revenue to pay for needed upgrades and investments that ensure reliable, good transit service.”

    Improving public transportation is also key to New York City’s post-pandemic economic recovery: If commutes to work are too unreliable, people are less likely to visit the office and shop at stores around their workplaces. Congestion charge advocates hope the program will create more space for amenities like wider sidewalks, bike lanes, plazas, benches, trees and public bathrooms.

    “100 years ago we decided the automobile was the way to go, so we narrowed sidewalks and built highways,” said Sam Schwartz, former New York City traffic commissioner and founder of an eponymous consulting firm. “But the future of New York City is that the pedestrian should be king and queen. Everything should be subservient to the pedestrian.”

    While no other US city has yet implemented congestion pricing, Stockholm, London and Singapore have had it for years.

    These cities have reported benefits like decreased carbon dioxide pollution, higher average speeds, and congestion reduction.

    Just one year after London added its charge in 2003, traffic congestion dropped by 30% and average speeds increased by the same percentage. In Stockholm, one study found the rate of children’s acute asthma visits to the doctor fell by about 50% compared to rates before the program launched in 2007.

    Some groups are fiercely opposed to congestion charges in New York City, however. Taxi and ride-share drivers, largely a low-income and immigrant workforce, fear it will hurt drivers already struggling to make ends meet. The MTA said congestion pricing could reduce demand for taxis by up to 17% in the zone.

    Commuters and legislators from New York City’s outer boroughs and New Jersey say the program hurts drivers who have no viable way to reach downtown Manhattan other than by car, and that this would disproportionately impact low-income drivers. (But out of a region of 28 million people, just an estimated 16,100 low-income people commute to work via car in Lower Manhattan, according to the MTA.)

    Other critics say it could divert more traffic and pollution from diesel trucks in Manhattan into lower-income areas like the Bronx, which has the highest rates of asthma hospitalization in the city.

    The MTA and other agencies have plans to mitigate many of these adverse effects, however.

    Taxis and for-hire vehicles will be tolled only once a day. Drivers who make less than $50,000 a year or are enrolled in certain government aid programs will get 25% discounts after their first 10 trips every month. Trucks and other vehicles will get 50% discounts during overnight hours.

    Additionally, the MTA pledged $10 million to install air filtration units in schools near highways, $20 million for a program to fight asthma, and other investments to improve air quality and the enviornment in areas where more traffic could be diverted.

    The stakes of New York City’s program are high, and leaders in other cities are watching the results closely.

    If successful, congestion pricing could be a model for other US cities, which are trying to recover from the pandemic and face similar challenges of climate change and aging public infrastructure.

    “It’s good to see New York City’s program is moving forward,” said the Los Angeles Times Editorial Board last month. “Los Angeles should watch, learn and go next.”

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  • Where to travel in 2023: The best destinations to visit | CNN

    Where to travel in 2023: The best destinations to visit | CNN



    CNN
     — 

    As peak vacation season sails into view and the world shakes off the last shackles of the pandemic, it feels like the appetite for hitting the road has never been greater.

    International tourism reached 80% of pre-pandemic levels in the first quarter of 2023, according to the United Nations World Tourism Organization, with an estimated 235 million tourists traveling internationally in January, February and March. And experts are cautiously optimistic about a continued travel rebound.

    Demand is high, with many popular destinations booking out earlier in the year.

    Thankfully, there’s so much out there still to see and do.

    Travel expert explains why you should book your dream vacation now

    Here are 23 destination ideas from CNN Travel to get you started:

    From the main square in Krakow, pictured, to forests, lakes and mountains, Poland invites exploration.

    We could list new openings in Poland – such as Hotel Verte, the new Autograph Collection property in Warsaw, which threw open its gilded doors (it’s in a humongous Baroque palace) last August. But the reason you should visit Poland in 2023 isn’t for the chance to stay in a place fit for royalty. It’s to show solidarity with a country which has, in turn, shown solidarity to the people of Ukraine.

    Sharing a 300-plus-mile border with a country under attack has meant that Poland has taken in more Ukrainian refugees than anywhere else. Add to that plummeting tourist numbers (though they’re on the rise again), and you have a tricky situation.

    So whether you fancy that Warsaw palace, a city break to the likes of Krakow, Gdansk, Wrocław or Poznań – all hundreds of miles from the Ukrainian border – or to get away from it all in the forests, lakes and mountains of the countryside – now’s your chance to do some good by taking a vacation. – Julia Buckley

    A full solar eclipse will be visible in April in Exmouth, Western Australia. The landscape is worth a long look, too.

    Back in April, thousands of people descended on the town of Exmouth and the greater Ningaloo Peninsula, to witness a rare total solar eclipse as it became visible over the northwestern edge of Australia.

    Organizers spent more than a year planning for the event, which lasted about a minute, and featured musical performances, educational opportunities to learn about science and astronomy, and a three-day festival.

    But the state of Western Australia offers much more than some 60 seconds of wonder.

    Spanning one-third of the entire continent of Australia, it stretches from the lively, growing state capital of Perth across deserts including the Great Victoria and Great Sandy to the wine country of Margaret River, the dramatic clifftops of the Kimberley and the quokka-covered Rottnest Island. – Lilit Marcus

    Mersey paradise: Liverpool.

    England’s port city of Liverpool, best known around the world as the birthplace of The Beatles, has added another chapter to its musical legacy.

    It’s the host city of Eurovision 2023, the spangly extravaganza of song that brings an influx of thousands of flag-waving fans from across the continent. The annual event is an opportunity for the city to bounce back after the ignominy of being stripped of its UNESCO World Heritage status in 2021.

    In June, the city will celebrate 25 years of the Liverpool Biennial contemporary visual arts festival, as more than 30 international artists and collectives take over spaces in the city until September.

    England is also marking the Year of the Coast in 2023, with food festivals and beach cleans taking place along the country’s shores. Just a half hour from Liverpool city center by train, Crosby Beach is the permanent home of sculptor Antony Gormley’s “Another Place,” where 100 cast-iron figures stand facing out to sea. – Maureen O’Hare

    Charleston, a city of undeniable refined, historic beauty, is also looking more closely at its troubled past.

    Charleston parades its past like no other US city, but it often glossed over the history of its Black residents. It’s been taking steps to fix that.

    Enter the much-delayed International African American Museum, which is now expected to open in late June.

    Located on the shoreline of the Cooper River in the spot where many Africans first set foot in North America, it will explore the lives of slaves and their descendants.

    Visitors in late May and early June can enjoy the world-renowned Spoleto Festival featuring opera, theater, dance, musical acts and artist talks.

    In March, foodies headed to the Charleston Wine and Food Festival to sample Lowcountry favorites.

    For fancy Southern fare, try Magnolias. Opened in 1990, it helped spur the city’s culinary renaissance. For something informal, try Bertha’s Kitchen in North Charleston, where red rice with sausage, fried chicken and lima beans rule. The eatery even caught attention of “Roadfood” author Michael Stern. – Forrest Brown

    Self-effacing Vilnius admitted in an ad campaign this year that nobody really knows where it is. If their brilliant video didn’t make you want to book a trip there immediately, perhaps this will: the capital of Lithuania celebrated its 700th anniversary on January 25, 2023.

    To mark the milestone, a packed program of events, including music festivals and exhibitions, are being held throughout the year. But use the anniversary as a push to visit rather than following a program religiously.

    The entire city center is a UNESCO World Heritage Site – putting it up there with its fellow V-cities, Venice and Vienna. Vilnius makes it on the list thanks to its Gothic, Renaissance and Baroque buildings, all sitting on a medieval street plan, but it’s best known for its Baroque architecture.

    Don’t miss the frothy bell tower of St. John’s church (you can climb it for sweeping city views) or the church of St. Casimir, topped by a giant crown. Got an eye for social media? This is Europe’s only capital city that allows hot air balloons to cruise over the city skyline. – JB

    Scenes like this await visitors to Fiji.

    Brilliant blue waters, expansive coral reefs and hundreds of peaceful islands: Fiji is not a hard sell. But why go there in 2023? For one, the country only reopened post-Covid at the end of 2021, meaning that visitor numbers to the South Pacific paradise have yet to fully rebound.

    While the country is spoiled for underwater beauty, take an opportunity to explore its above-ground treasures, too. The country’s lone UNESCO World Heritage site is the town of Levuka, a former capital and an important port, which is studded with British colonial-era buildings amid coconut and mango trees.

    To learn about the local Indigenous communities, travelers can take part in a kava welcoming ceremony – named for the traditional drink at its center – or enjoy a lovo, a meal cooked by hot coals in an underground pit covered with banana leaves.

    Fiji Airways now has direct flights from Los Angeles and San Francisco, making it relatively easy to get to the islands. As the Fijians say, bula! – LM

    As the fate of the Amazon rainforest hangs in the balance, two eco-lodges around Manaus – the capital of Brazil’s Amazonas state, and gateway to the river – have used their pandemic pause to get even more environmentally friendly.

    Juma Amazon Lodge, about 50 miles south of the city, is now fully powered by a new $400,000 solar plant, whose 268 double panels swagger nearly 40 feet into the air above the canopy (meaning no trees had to be cut). They’ve also built a biogas system to increase the efficiency of organic waste treatment, reducing annual carbon emissions by eight tons.

    Meanwhile, Anavilhanas Jungle Lodge, northwest of Manaus on the Rio Negro river, opened an off-grid “advanced base” during the pandemic that’s 30 miles from the main lodge and accessible only via river.

    Guests can take long jungle hikes through territory home to jaguars, pumas and giant armadillos in what’s one of the Amazon region’s most remote hotel facilities, then spend the afternoon in a hammock or by the pool. For 2023, the lodge is planning overnight stays in a creekside tent for small groups.

    Don’t miss Manaus itself – eating behemoth Amazonian fish outside the pink 1896 opera house is a bucket list experience. – JB

    Enticing flavors, history and proximity to beaches and mountains are just a few factors working in this Greek city's favor.

    There’s been no shortage of reasons to visit Greece’s second city in recent times, with a UNESCO-endorsed local food scene that recently celebrated the refurb and reopening of its century-old Modiano food market.

    Throw in a popular waterfront and proximity to beautiful beaches and inland mountains, Thessaloniki is surely a contender for one of Europe’s best city-break destinations.

    What could make it even better? How about a gleaming new metro system? All being well, November 2023 should see the opening of the main line of an infrastructure megaproject that will eventually connect the city’s downtown to its international airport. Driverless trains will whisk passengers through tunnels whose excavation has added to Thessaloniki’s already rich catalog of archeological discoveries, many of which will be on display in specially created museum stations. – Barry Neild

    January 2023 saw the official opening of Rwanda’s most exciting hotel yet: Sextantio Rwanda, a collection of traditionally crafted huts on an island on Lake Kivu, one of Africa’s largest lakes.

    It’s the first project outside Italy for Daniele Kihlgren, whose part-hotel, part-living history projects keep local tradition alive. A nonprofit delivering money straight to local communities, Sextantio sees guests fishing on the 1,000-square-mile lake, paddling in dug-out canoes, trying local banana beer and wildlife-spotting – and not just the chickens, cows, pigs and goats that roam around the property.

    Of course, you’ll want to see gorillas. Adjoining Volcanoes National Park, the Dian Fossey Gorilla Fund opened the 4,500-square meter Ellen DeGeneres Campus in 2022. Its visitor center includes exhibits, virtual reality gorilla “encounters” and nature trails.

    Over in Akagera National Park, white rhinos – transferred from South Africa in 2021 to aid conservation – are already calving. It’s easier to get there, too. A new route from London joins Brussels, Dubai, Guangzhou and Mumbai as the only direct flights to Kigali from outside the African continent. – JB

    Voted the world’s most sustainable destination in the world for six years running, Sweden’s second-biggest city is finally emerging from the shadow of Stockholm.

    Once a major trading and shipping town, Gothenburg is now considered to be one of the greenest destinations in Europe, with 274 square meters (2,950 square feet) of green space per citizen, while 95% of its hotels are certified as eco-friendly.

    Although Gothenburg officially turned 400 in 2021, the celebrations were put on ice because of the global pandemic. But they’re finally taking place in 2023, so it’s a great time to visit.

    Sweden’s King Carl XVI Gustav, who celebrates 50 years on the throne this year, will be in town on June 4, Gothenburg’s official birthday, and the city’s major anniversary festival is being held in the Frihamnen port district from June 2 to 5, with concerts and art events among the activities on offer.

    The festivities will continue throughout the summer until the September 3 kick off of Göteborgsvarvet Marathon, a new 26-mile race following on from the city’s popular half marathon on May 13. – Tamara Hardingham-Gill

    The Dhayah Fort in Ras al-Khaimah is one of the few remaining hill forts in the United Arab Emirates.

    When travelers think of the United Arab Emirates, the dazzling skyline of Dubai is usually what springs to mind.

    But the UAE has a lot to offer nature lovers too – particularly the northernmost emirate Ras al-Khaimah, which is aiming to become the Middle East’s most sustainable destination by 2025 thanks to a new “Balanced Tourism” strategy.

    Just 45 minutes from Dubai, it’s often called the “adventure Emirate,” and for good reason. Offering beaches, deserts and mountains, outdoor attractions abound, such as sand boarding, trekking, wakeboarding, skydiving, scuba diving and even the world’s longest zipline.

    But it’s not all about the adrenaline rush. Ras Al Khaimah is where you’ll find the highest restaurant in the United Arab Emirates, 1484 by Puro, which sits in the emirate’s Jebel Jais Mountains. Culture seekers can head for the historic Dhayah Fort, which dates back to the Late Bronze Age (1600-1300 BC).

    Where to stay? Luxury hospitality brand Anantara is opening a fabulous new resort there later this year that will offer 174 guestrooms, suites and overwater villas along with specialty restaurants and a spa. – Karla Cripps

    Three-tiered Kuang Si Falls is just south of UNESCO-listed Luang Prabang.

    Sharing borders with Thailand, Cambodia, Vietnam, China and Myanmar, landlocked Laos has long been a must-hit spot for time-rich travelers making their way through the Southeast Asia circuit.

    But now, thanks to the 2021 opening of a semi-high-speed railway, it’s easier than ever to get around the country at a quicker pace, shaving hours off journeys that previously took full days to travel.

    You’re still going to have to make some hard choices – there’s a lot to see in Laos.

    Towering karst peaks await visitors to adventure-haven Vang Vieng, while UNESCO-listed Luang Prabang is filled with French-colonial heritage, Buddhist ritual and natural beauty. (Luxury seekers will want to check into the Rosewood Luang Prabang, with its stylish hilltop tents)

    The mysterious Plain of Jars, a megalithic archaeological site, can be found in the Xiangkhoang Plateau. For a once-in-a-lifetime experience that makes a difference, head for Bokeo Province and join one of the Gibbon Experience’s overnight treks. Guests of this tourism-based conservation project spend the night in the world’s tallest treehouses – only accessible by zipline – among wild, black-crested gibbons. – KC

    Rolling hills, medieval buildings – and the officially crowned world’s best cheese. Welcome to Gruyères, Switzerland.

    Everywhere you look in this tiny, hilltop town, there’s a different picture-perfect view – from the medieval market square to the turreted 13th-century castle. A doable day trip from Geneva, summer promises hiking opportunities aplenty, while winter allows for venturing to the nearby Moléson-sur-Gruyères ski resort.

    To taste Gruyères’ namesake fromage, stop off at the wood-lined Chalet de Gruyères. And to learn how cheesemakers perfect this creamy goodness, head to La Maison du Gruyère factory. For further foodie delights, there’s the Maison Cailler chocolate factory – from the outside it looks like something from a Wes Anderson movie, inside it offers a glimpse into the secrets of Swiss chocolate making.

    Gruyères is also home to the surreal HR Giger Museum, celebrating the work of the acclaimed Swiss artist behind the eponymous alien in the 1979 movie “Alien.” A drink at the museum’s bar, designed by Giger in an eerie skeletal aesthetic, offers an antidote to Gruyères’ fairytale vibe. – Francesca Street

    A modern Indigenous restaurant in Minneapolis has earned one of the culinary world’s highest honors, and it’s not alone in shining light on Native communities in the area.

    At Owamni, a James Beard Award winner for best new restaurant, Indigenous ingredients – trout, bison, sweet potatoes and more – make up “decolonized” menus where ingredients such as wheat flour and beef are absent. The restaurant is a partnership between chef Sean Sherman, Oglala Lakota and Dana Thompson, who is a lineal descendant of the Wahpeton-Sisseton and Mdewakanton Dakota tribes.

    Earlier this year, one of the pair’s community-owned initiatives, Indigenous Food Lab, opened a market in Minneapolis’ Midtown Global Market, a former Sears building housing businesses that represent more than 22 cultures.

    The open-air Four Sisters Farmers Market (Thursdays June through October) also focuses on Indigenous products. And at the Minnesota History Center in neighboring St. Paul, the exhibit “Our Home: Native Minnesota” looks at thousands of years of Native history in the state. – Marnie Hunter

    While Colomia's busy capital can be congested, it's also home to the historic neighborhood of La Candelaria.

    Caribbean coast destinations such as the Rosario archipelago or the UNESCO heritage list city of Cartagena are rightly top of most Colombia travel wish lists, but also deserving a look-in is the country’s somewhat unsung capital of Bogotá.

    Yes, it’s a messy, traffic-snarled urban sprawl, but it’s also a high-altitude crucible of culture and cuisine. There are tours that chart the city’s transformation from graffiti wild west to incredible street art gallery.

    Equally colorful are the restaurants that make the most of Colombia’s diverse natural larder of flora on menus that range from delicious peasant dishes to mind-blowing Michelin-level gastronomy. And then there’s the coffee!

    The congestion (except on regular cycle-only days) thins quickly on its outskirts, allowing day trips to see historic and modern treasures. Itineraries include Lake Guatavita, where conquistadors once plundered sunken gold offerings left by indigenous Muisca people, or the majestic subterranean Zipaquirá salt cathedral. – BN

    Famed for its mountain treks through ancient trails that once facilitated trade between the Himalayas and India, Nepal’s stunning Mustang Valley sits on the doorstep of Tibet.

    Expect to hear a lot more about this remote destination in the coming months thanks to the arrival of the soon-to-open Shinta Mani Mustang. Part of the Bensley Collection, this all-inclusive resort perched above the small town of Jomsom in the Lower Mustang will offer luxury seekers 29 suites inspired by traditional Tibetan homes.

    In addition to trekking, Mustang visitors can explore ancient villages and Buddhist monasteries. Also not to be missed, the man-made Mustang Caves sit above the Gandaki River and are filled with 2,000-year-old Buddhist sculptures and paintings.

    Getting to the Mustang Valley is part of the adventure. Travelers will need to take a 25-minute flight from capital Kathmandu to Pokhara then hop on another plane for the 20-minute journey to Jomsom. The views alone might make this option more pleasing to some than the alternative – a 12-hour drive from Kathmandu. – KC

    From the spectacular wildlife to the beautiful national parks and beaches, Tanzania is absolutely bursting with visual splendor.

    The East African country holds a seemingly endless list of incredible sights, with Mount Kilimanjaro, Africa’s highest mountain, UNESCO world heritage site Serengeti National Park, and the Zanzibar Archipelago, among its many highlights.

    This year, flag carrier Air Tanzania will launch new routes to West and Central Africa, along with the UK, in a bid to transform the country’s largest airport in Dar es Salaam into a transport and logistics hub, while construction on the country’s first toll expressway is also scheduled to begin.

    Meanwhile, the Delta Hotels by Marriott brand made its Africa debut with the opening of its Dar es Salaam Oyster Bay property earlier this year. –– THG

    Cairo is pulsing with life and a rich blend of cultures.

    Could this finally be the year tourists can see the Grand Egyptian Museum? After delay upon delay, the museum is expecting a 2023 opening.

    GEM will be the largest museum dedicated to a single civilization, costing around $1 billion and holding the entire King Tut collection. See video here of a CNN insider visit.

    If you arrive in Cairo before it opens, the Egyptian Museum in Tahrir Square can still scratch your antiquity itch.

    While the Pyramids of Giza are the city’s tour-de-force, there’s still more to see. Start with Islamic Cairo. This area has one of the largest collections of historic Islamic architecture in the world. While there, visit the Al-Azhar mosque, which dates back to 970.

    The city also has a rich Christian tradition. Coptic Cairo, part of Old Cairo, has a concentration of Christian sites that pre-date the arrival of Islam.

    If you need a respite from Cairo’s cacophony, Al Azhar Park has a nice expanse of greenery and a design inspired by historic Islamic gardens. And the affluent neighborhood of Zamalek, which sits on an island in the Nile River, serves up restaurants, antique stores and swanky hotels. – FB

    Yayoi Kusama has the distinction of being the best-selling living female artist on the planet. In particular, she has become a global icon for her sculptures of giant polka-dotted pumpkins, one of which was reinstalled at the pier of Naoshima, one of Japan’s “art islands,” in 2022 after being swept into the sea the year before.

    However, Naoshima is so much more than its famous yellow gourd or its works by Kusama.

    There are five small, walkable “art islands” in the Seto Inland Sea, which is located between the main islands of Honshu, Kyushu and Shikoku in southeastern Japan. The largest collection of things to see – not to mention the only hotel – is on Naoshima. Together, the five champion modern and contemporary art, with emphasis on Japanese artists.

    Don’t come here expecting calligraphy and other classical forms. Instead, be awed by Tadao Ando’s massive stone monoliths, a tiny gallery where patrons can listen to nothing but the beats of human hearts, a makeshift thunderstorm created inside a wooden house and an exhibit where jumping in and taking a bath is intended to be part of the artistic experience. – LM

    With direct flights to Belize City from about a dozen North American airports, this Central American country is a low-hassle hop for many travelers during the November to April high season.

    Most visitors head directly to Belize’s Caribbean coastline. The country’s largest island, Ambergris Caye, sits next to Belize Barrier Reef – the world’s second largest coral reef system. Margaritaville Beach Resort opened on the island in March, and “eco-luxury” resort Alaia Belize opened in 2021.

    Farther south, the Great Blue Hole – a massive underwater sinkhole – is an aquatic magnet for both scuba divers and aerial photographers.

    But Belize offers way more than its enticing islands.

    Lush rainforests, cave networks, winding rivers and rich Mayan archaeological sites invite exploration in a country that’s had an evolving sustainable tourism master plan since 2012. Ruins of the Mayan city of Altun Ha are just about an hour north of Belize City. Or farther west, Lamanai is one of Belize’s largest and most fascinating Mayan sites. – MH

    Mexico is arguably as rich in culinary heritage as it is in Mesoamerican archaeological treasures, and Eva Longoria explores many distinctive flavors in her series “Searching for Mexico,” which aired on CNN this year.

    The state of Oaxaca, which Longoria visits, has an especially deep well of culinary traditions. Plus, Oaxaca produces most of the world’s mezcal.

    Tlayudas, known as Oaxacan pizzas, are a street food staple. A large corn tortilla is typically layered with lard, beans, traditional Oaxacan cheese, pork and other toppings such as avocado and tomato. The state is also renowned for its seven mole sauces, with recipes that may call for dozens of ingredients from chiles and sesame seeds to chocolate and dried fruit.

    In the city of Oaxaca, Mercado Benito Juárez is one of many markets across the state selling items such as dried chiles, fresh produce, handicrafts and crunchy grasshoppers. To sample the state’s increasingly popular beverage, the town of Santiago Matatlán is the place for mezcal distillery tours and tastings. – MH

    In the winter, the frozen Rideau Canal in Ottawa becomes the world's largest skaing rink.

    It doesn’t have Montreal’s French flair or Toronto’s international oomph, so the Canadian capital can get overlooked. That would be a mistake. Graceful and understated, Ottawa has its own draws.

    Music lovers should take note of two Ottawa Jazz Festivals. The winter edition took place in February, and the summer edition will run from June 23-30.

    If you love hockey, watch the Ottawa Senators do their NHL thing at the Canadian Tire Centre in the western suburbs. If that ticket is too pricey, check out the Ottawa 67’s, a more affordable option of junior men’s hockey games at downtown’s TD Place Arena.

    The Rideau Canal turns into the world’s largest skating rink from sometime in January to late February or early March, depending on ice thickness. It’s free and accessible 24/7. When it’s warmer, it’s a great spot for people and boat watching.

    A don’t-miss is Parliament Hill, home to Canada’s federal government and the visually striking Parliament buildings on a promontory overlooking the Ottawa River. – FB

    Treks through the Bwindi Impenetrable Forest are among Uganda's highlights.

    There’s considerable change brewing in Uganda’s travel offerings at the moment with the East African country looking beyond the traditional staples of safari and wildlife spotting to appeal to both regional and international visitors.

    Keen to revitalize post-Covid tourism in all corners of the country, not just the big-ticket businesses offering wealthy visitors a glimpse of the Big Five beasts or mountain gorillas, it’s turned to marketing its other attributes.

    And why not? From the expansive shores of Lake Victoria to the snowy Rwenzori Mountains, Uganda is a beautiful wilderness playground, with opportunities for adventure including treks through the Bwindi Impenetrable Forest or up to the craters of the Virunga volcano chain or whitewater rafting along the Victoria Nile.

    There’s also an emphasis on connecting visitors with Ugandan communities – promising tastes of Ugandan food, music and culture. Last year saw the launch of the Uganda Cycling Trail, a 1,600-kilometer mainly unpaved 22-stage route designed to appeal to all levels of cyclist from hardcore solo bikepackers to fully-guided easy riders. – BN

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  • The ‘Engagement Gap’: Ring sales stall as the pandemic put love in limbo | CNN Business

    The ‘Engagement Gap’: Ring sales stall as the pandemic put love in limbo | CNN Business


    New York
    CNN
     — 

    It seems to be a turbulent time for retailers who cater to couples in love.

    On the heels of David’s Bridal, the largest seller of wedding dresses declaring bankruptcy last week, another big seller of symbols of enduring love, like rings, disclosed that their business has not yet recovered from Covid-19.

    According to Signet Jewelers, the largest jewelry company in the United States, the pandemic dented sales of engagement rings as relationships faltered or never even blossomed in the first place due to the lockdowns.

    Signet Jewelers

    (SIG)    , with brands including Zales, Jared, Kay Jewelers and Diamonds Direct under its corporate umbrella, said a lot of early relationships in particular faded as lockdowns began in the winter and spring of 2020, only to be followed by a dramatic decline in dating.

    This created, it said, an “engagement gap.”

    “We’re still seeing it today,” Jamie Singleton, Signet Jewelers’ president and chief consumer officer, said during the company’s investor day last week.

    Citing company research, Singleton said couples, on average, get engaged about 3.25 years after they begin dating.

    “So what’s happened over the past couple of years is what we anticipated and what we planned for,” she said. “Engagement jewelry sales were lackluster in fiscal 2023, and we expect them to remain so for the balance of fiscal 2024.”

    The category will need to grow approximately 25% by calendar year 2026 just to return to prior engagement levels, she said.

    But there’s some evidence of a turnaround, said Singleton. And it’s vital for Signet’s business, because 50% of the company’s merchandise sales come from the bridal segment.

    “As people begin getting back out after the lockdowns, we monitored the return of dating…. Dating, in fact, is up 8% to pre-Covid.”

    It doesn’t mean engagements will suddenly rebound overnight, but that the potential is promising for a coming pickup in engagements. “We’re confident in the turn that’s coming,” she said.

    Signet Jewelers CEO Virginia C. Drosos told investors that the company is striving to reach a $9 billion to $10 billion revenue target annually in the next three to five years “as engagements return to normal levels.” Signet, she said, currently has 30% share of the bridal jewelry market.

    “We’ve been anticipating this coming tailwind,” she said. “We expect this to drive significant upside in our business over the coming years.

    Meanwhile, the pandemic also walloped sales of wedding dresses as social gatherings of all kinds came to a standstill, and couples postponed their weddings.

    As dates were re-booked coming out of the pandemic, brides-to-be have had to contend with inflation and economic uncertainty bearing down on expenses.

    David’s Bridal said these macro trends, as well as competition from more affordable online and secondhand retailers, hurt its business.

    “An increasing number of brides are opting for less traditional wedding attire, including thrift wedding dresses. These shifting consumer preferences have significantly exacerbated the company’s financial crunch,” David’s Bridal said in a bankruptcy filing.

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  • 600-plus inmates to be transferred as Fulton County, Georgia, jail deals with overcrowding and outbreak of bedbugs and vermin | CNN

    600-plus inmates to be transferred as Fulton County, Georgia, jail deals with overcrowding and outbreak of bedbugs and vermin | CNN



    CNN
     — 

    Fulton County, Georgia, Sheriff Patrick “Pat” Labat on Friday announced measures “to address an outbreak of infectious illnesses” at the county jail – including moving more than 600 inmates to other counties, a statement said.

    The measures are the result of a “preliminary investigation” into the death of Lashawn Thompson – an incarcerated man who died in the jail last year, the announcement posted on Facebook said. Thompson’s family says his death was the result of unsanitary conditions at the facility and complications from insect bites, CNN has reported.

    The sheriff said Friday that “an emergency expenditure of $500,000” has been approved to address the jail’s “infestation of bed bugs, lice and other vermin.”

    The sheriff said protocols for security rounds will also be updated to help mitigate the outbreak as well as “transferring more than 600 inmates to other counties in an effort to help relieve overcrowding, at an average cost of approximately $40K/day.”

    It’s unclear where or when the incarcerated persons will be moved.

    The announcement began with the sheriff’s office expressing condolences to Thompson’s family and saying the sheriff has launched “a full investigation into the circumstances surrounding his death.”

    Lashawn Thompson in a family photo.

    On Thursday, Thompson’s family held a news conference to demand a criminal investigation into his death and for the jail to be closed.

    Thompson died while in custody last September. His family’s attorney, Michael Harper, blamed unsanitary conditions and complications from insect bites for Thompson’s death.

    Holding up photos purporting to show conditions in Thompson’s jail cell, Harper said, “The cell he was in was not fit for a diseased animal. This is inexcusable and it’s deplorable.”

    Harper said that Thompson had been in custody on a misdemeanor assault charge since June of 2022 and was housed in the psychiatric wing of the jail because he suffered from mental health issues.

    Brad McCrae, Thompson’s brother, told reporters Thompson was 35 years old, was born in Winter Haven, Florida, and had been living in Atlanta on and off over the last couple of years.

    When asked by a reporter what he thought when he saw images of his brother’s body and the conditions of his cell, McCrae said, “It was heartbreaking because nobody should be seen like that. Nobody should see that. But the first thing that entered my mind was Emmett Till.”

    The Fulton County Sheriff’s Office said in a statement Thursday, “The manner and cause of death was listed as ‘undetermined’ by the county medical examiner. A full investigation was launched into the circumstances surrounding Mr. Thompson’s death.”

    The statement went on to say that the results of that investigation would determine if any criminal investigation is warranted.

    The sheriff’s statement acknowledged the “dilapidated and rapidly eroding conditions” at the jail and said that Labat continues to call for the building of a new jail.

    The family has not filed a lawsuit at this time.

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  • Japan was already grappling with isolation and loneliness. The pandemic made it worse | CNN

    Japan was already grappling with isolation and loneliness. The pandemic made it worse | CNN


    Tokyo
    CNN
     — 

    Across Japan, nearly 1.5 million people have withdrawn from society, leading reclusive lives largely confined within the walls of their home, according to a new government survey.

    These are Japan’s hikikomori, or shut-ins, defined by the government as people who have been isolated for at least six months. Some only go out to buy groceries or for occasional activities, while others don’t even leave their bedrooms.

    The phrase was coined as early as the 1980s, and authorities have expressed increasing concern about the issue for the past decade – but Covid-19 has made things worse, according to a survey conducted last November by the government’s Children and Families Agency.

    The nationwide survey found that among 12,249 respondents, roughly 2% of people aged 15 to 64 identified as hikikomori, with a slight increase among those aged 15 to 39. With that percentage applied to Japan’s total population, there are an estimated 1.46 million social recluses in the country, according to a spokesperson from the agency.

    Common reasons cited for social isolation were pregnancy, job loss, illness, retirement and having poor interpersonal relationships – but a top reason was Covid-19, with more than a fifth of respondents citing the pandemic as a significant factor in their reclusive lifestyle.

    No further details were given about the impact of Covid-19 on respondents.

    Japan, like many countries in East Asia, maintained stringent pandemic restrictions well into 2022 even as other places embraced “living with Covid.” It only reopened its borders to overseas visitors last October, ending one of the world’s strictest border controls, more than two years after the pandemic began.

    But the toll of the last few years continues to be deeply felt.

    “Due to Covid-19, opportunities for contact with other people have decreased,” said a separate paper published February in Japan’s National Diet Library.

    It added that the pandemic could have worsened existing social problems like loneliness, isolation and financial hardship, pointing to a rise in reported suicides, and child and domestic abuse.

    Experts have previously told CNN that hikikomori is often thought to stem from psychological issues such as depression and anxiety, though societal factors play a role too, such as Japan’s patriarchal norms and demanding work culture.

    But hikikomori had been around long before the pandemic, tied to Japan’s other looming problem: its population crisis.

    Japan’s population has been in steady decline since its economic boom of the 1980s, with the fertility rate and annual number of births falling to new record lows several years in a row.

    All the while, the elderly population is swelling as people age out of the workforce and into retirement, spelling trouble for an already stagnant economy. Things are so dire the prime minister warned this year that the country was “on the brink of not being able to maintain social functions.”

    For families with hikikomori members, this poses a double challenge, dubbed the “8050 problem” – referring to social recluses in their 50s who rely on parents in their 80s.

    Authorities have cited other factors, too, like the rising number of single adults as the appeal of dating and marriage wane, and weakening real-life ties as people move their communities online.

    In 2018, Japan’s Ministry of Health, Labor and Welfare established a hikikomori regional support body to help those impacted by the phenomenon.

    “We believe that it is important to restore ties with society while providing detailed support for those who have withdrawn by attending to their individual situations,” said Takumi Nemoto, then-head of the ministry, in 2019.

    He added that local and national authorities had launched various services such as consultations and home visits to those affected by hikikomori, housing support for middle-aged and older people, and other community outreach efforts for “households that have difficulty reporting an SOS on their own.”

    But these efforts were dwarfed by the challenges brought during the pandemic, prompting the government to carry out nationwide surveys on loneliness starting 2021, and to release a more intensive plan of countermeasures in December 2022.

    Some measures include pushing public awareness and suicide prevention campaigns through social media; assigning more school counselors and social workers; and continuing a 24/7 phone consultation service for those with “weak social ties.”

    There are also programs geared toward single-parent households such as meal plans for their children, housing loans, and planning services for those going through divorce.

    Though the pandemic may have caused greater loneliness in society, it may also have simply shed light on long-existing problems that usually go overlooked, said the government in the plan.

    “As the number of single-person households and elderly single-person households is expected to increase in the future, there is concern that the problem of loneliness and isolation will become more serious,” it said.

    “Therefore, even if the spread of Covid-19 is brought under control in the future, it will be necessary for the government to … deal with the problems of loneliness and isolation inherent in Japanese society.”

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  • FDA inspection finds sterilization issues at recalled eye drop manufacturer’s facility | CNN

    FDA inspection finds sterilization issues at recalled eye drop manufacturer’s facility | CNN



    CNN
     — 

    The manufacturer of eye drops that have been linked to an outbreak of serious bacterial infections in the US, including at least three deaths, did not follow proper protocol to prevent contamination of its products, according to an inspection report published Friday by the US Food and Drug Administration.

    The FDA visited a Global Pharma Healthcare facility in India for an inspection that started in mid-February, 2½ weeks after the company recalled EzriCare Artificial Tears due to possible contamination.

    At the time of the recall, there were 55 reports of adverse events including eye infections, permanent loss of vision and at least one death with a bloodstream infection. As of late last month, 68 infections had been identified in 16 states, according to the US Centers for Disease Control and Prevention. There have been three deaths, eight cases of vision loss and four surgical eye removals reported.

    An 11-day inspection of the Global Pharma facility resulted in 11 observations by the FDA, including a “manufacturing process that lacked assurance of product sterility,” specifically for batches of product that were manufactured between December 2020 and April 2022 and shipped to the US.

    The EzriCare Artificial Tears product, which is manufactured by Global Pharma, is part of an outbreak of infections from bacteria called Pseudomonas aeruginosa.

    This rare drug-resistant bacteria can spread among people who don’t have symptoms – and to people who haven’t used the eye drops, according to the CDC. This type of spread is particularly common in health care settings.

    “The bacteria can spread when one patient carrying the bacteria exposes another patient, or when patients touch common items or when healthcare workers transmit the germs which is why infection control, like hand hygiene, is so important,” the agency told CNN in an email Monday.

    Several cases in the current outbreak have been identified in people who were carrying the bacteria without signs or symptoms of clinical infections, the CDC said. These cases were discovered through screenings at inpatient health care facilities that had clusters of infections.

    The particular strain of the bacteria associated with this outbreak had never before been reported in the US, and related infections have been identified at acute care hospitals, long-term care facilities, emergency departments, urgent care clinics and other outpatient facilities.

    People affected by the outbreak reported using different brands of artificial tears, but EzriCare Artificial Tears was most commonly reported.

    The FDA inspection of the Global Pharma facility is part of an ongoing compliance matter.

    “The FDA’s highest priority is protecting public health – this includes working with manufacturers to quickly remove unsafe drugs from shelves when they are identified,” the agency said in an email Monday. “The FDA continues to monitor this issue and is working with the Centers for Disease Control and Prevention (CDC) and the companies recalling these affected products. We urge consumers to stop using these products which may be harmful to their health.”

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  • CDC to warn some travelers to watch for Marburg virus symptoms as it investigates outbreaks in Africa | CNN

    CDC to warn some travelers to watch for Marburg virus symptoms as it investigates outbreaks in Africa | CNN



    CNN
     — 

    The US Centers for Disease Control and Prevention is sending personnel to Africa to help stop outbreaks of Marburg virus disease and is urging travelers to certain countries to take precautions. The CDC is also taking steps to keep infections from spreading to the United States.

    Equatorial Guinea and Tanzania are facing their first known outbreaks of Marburg virus, a viral fever with uncontrolled bleeding that’s a close cousin to Ebola. This week, the CDC urged travelers to both countries to avoid contact with sick people and to watch for symptoms for three weeks after leaving the area. Travelers to Equatorial Guinea should take enhanced precautions and avoid nonessential travel to the provinces where the outbreak is ongoing, the agency said.

    In the United States, the agency will post notices in international airports where most travelers arrive, warning them to watch for symptoms of the virus for 21 days and to seek care immediately if they become ill. They will also get a text reminder to watch for symptoms.

    The CDC is standing up a “center-led” emergency response; it’s not as all-encompassing as when the CDC stands up its Emergency Operations Center, such as for Covid-19 and mpox. But it will refocus the efforts and attention of the staff of its National Center for Emerging and Zoonotic Infectious Diseases to respond to the outbreaks, which are in two countries on opposite sides of Africa, indicating that the deadly hemorrhagic fever is spreading.

    Equatorial Guinea, on the coast in West Africa, declared an outbreak of Marburg virus disease in mid-February with cases spread across multiple provinces. As of March 22, Equatorial Guinea had 13 confirmed cases, including nine people who have died and one who has recovered, according to the World Health Organization. Nine CDC staffers are on the ground there. They have established a field laboratory and are assisting with testing, case identification and contact tracing.

    Tanzania, on the coast in East Africa, declared an outbreak of Marburg virus disease on March 21, with cases reported in two villages in the Kagera region, according to the CDC. As of March 22, Tanzania has had eight confirmed cases, including five deaths. The CDC has a permanent office in Tanzania that is assisting with the outbreak. It is sending additional staff to support those efforts.

    Marburg virus is a rare and deadly virus that causes fever, chills, muscle pain, rash, sore throat, diarrhea, weakness or unexplained bleeding or bruising. It is spread through contact with body fluids and contaminated surfaces. People can also catch it from infected animals. It is fatal in about half of cases who get it. Other countries in Africa have had to quell outbreaks before.

    In its early stages, the infection is difficult to distinguish from other illnesses, so a history of travel to either of those countries will be essential to helping clinicians spot it.

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  • A hidden pandemic: the orphans Covid has left behind | CNN

    A hidden pandemic: the orphans Covid has left behind | CNN



    CNN
     — 

    “Papa died last night, but his death is not the end.”

    Those are the first words Veronica Fletcher uttered to her three children after her husband, Joseph Fletcher, died from Covid-19 on April 11, 2020.

    “We’re going to keep papa’s name alive,” Fletcher, 49, later told her children. “He lives in us.”

    The Fletchers’ 17-year-old son, Joshua, recalled the day his mother told him about the death of his “papa”: “It’s so real, but not real at the same time,” he said. He says he felt compelled to step into his father’s shoes as the eldest child.

    “Being a better role model for my siblings,” he told CNN. “Instilling things that I learned from my father that they might not have the opportunity to have because they didn’t have as much time with him that I did.”

    Joshua, his younger brother, Zachary, 14, and sister, Maddie, 10, are among the estimated 238,500 Covid orphans in the United States whose lives have been upended in the past three years by the loss of a parent or primary caregiver, according to the Imperial College London COVID-19 Orphanhood Calculator. Globally, there have been more than eight million Covid orphans since the World Health Organization declared Covid-19 a pandemic in March 2020.

    Orphanhood increases the likelihood of poverty, abuse, delayed development, mental health challenges and reduced access to education, according to the Centers for Disease Control and Prevention.

    Veronica Fletcher grew up an orphan – her father was not present during her childhood and her mother died when she was nine.

    “To be able to usher my children through this loss, it comes from 40 years of pain and knowing what that little nine-year-old girl needed and received,” said Fletcher as she recalled the day she learned of her mother’s death. “To lose a parent is traumatic, and the way the parents were lost during the pandemic, to have to grieve in isolation, that compounds the pain exponentially.”

    Christopher Kocher is honoring those who died from Covid and supporting those who survived through his organization, COVID Survivors for Change. The group offers resources and programs to families like the Fletchers. It also pushes for legislative and cultural change. Kocher says much more needs to be done for Covid orphans.

    “I was in New York on 9/11. I know how much the city and the nation stepped up to support those families,” Kocher told CNN. “We need to see something similar here. We’re fighting to make sure that we hear a lot more from the president, from the states around the country and from local communities to make sure that they are providing the support that these children need.”

    Targeted efforts are gaining traction in many states, albeit slowly.

    California state Sen. Nancy Skinner helped her state become the first in the country to pass legislation in June 2022. She introduced a bill strengthening the HOPE (Hope, Opportunity, Perseverance and Accountability) Account law she authored last year. That law made California the first in the nation to create savings accounts for children who lost a parent or guardian to Covid. The California State Budget Act of 2022-23 included $100 million to fund the HOPE program.

    California is one of six states that accounts for half of national caregiver loss. New York is another state and has become the second in the nation to introduce legislation that would fund scholarships for children who lost a parent or caregiver to Covid. Each qualifying student would be eligible for a scholarship that covers the equivalent cost of SUNY tuition, plus room and board, books as well as supplies.

    New York’s legislation, if approved, would come too late for Joshua Fletcher’s first year of college. “I got accepted into schools that I wanted to go to, but I couldn’t afford to go to them because papa died,” he said. However, Joshua would be eligible for his remaining years of college.

    Asian, Hispanic and Black families are more likely to experience a loss, with Black families, like the Fletcher family, twice as likely to suffer from a Covid death, according to the National Institutes of Health.

    “Pain is pain, trauma is trauma,” Veronica Fletcher said. “This power is turning your pain into purpose. Those are the kinds of lessons that are helping my children to find hope, to be resilient, to know that they’re not alone. It helps you to help someone else.”

    It’s why Fletcher now finds support through external groups, such as COVID Widow Sisters, which connects grieving wives across the country. Fletcher also plans to start her own organization, Widows Tears Collective, a support group for women who have lost loved ones to the illness.

    “Especially early on the pandemic, you didn’t get to say goodbye. You didn’t get to be in the hospital. You didn’t get to hold their hand. That loss impacts you dramatically and sits with you for a really long time,” Kocher said. “When that loss is for a young person, someone who’s losing a parent, it’s a really different kind of loss.”

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  • Pandemic lowered US step count and Americans haven’t bounced back, study says | CNN

    Pandemic lowered US step count and Americans haven’t bounced back, study says | CNN

    Editor’s Note: Sign up for CNN’s Fitness, But Better newsletter series. Our seven-part guide will help you ease into a healthy routine, backed by experts.



    CNN
     — 

    Americans took fewer steps during the height of the Covid-19 pandemic, and they still haven’t gotten their mojo back, a new study found.

    “On average, people are taking about 600 fewer steps per day than before the pandemic began,” said study author Dr. Evan Brittain, associate professor of cardiovascular medicine at Vanderbilt University Medical Center in Nashville.

    “To me, the main message is really a public health message — raising awareness that Covid-19 appears to have had a lasting impact on people’s behavioral choices when it comes to activity,” he said.

    The study used data from the National Institutes of Health’s All of Us Research Program, which is focused on identifying ways to develop individualized health care. Many of the 6,000 participants in the program wore activity trackers for at least 10 hours a day over multiple years and allowed researchers access to their electronic health records.

    Brittain and his colleagues have used the ensuing data before, publishing a study in October 2022 that found overweight people could lower their risk of obesity by 64% by increasing their steps taken from about 6,000 to 11,000 per day.

    In the new study, published Monday in JAMA Network Open, researchers compared steps taken by nearly 5,500 people who wore the program’s activity trackers. Most were White women, with an average age of 53.

    Step counts collected between January 1, 2018, and January 31, 2020, were considered pre-Covid. Steps tracked after that date until the end of 2021, which is when the study ended, were considered post-Covid.

    Results showed no difference in identified step activity based on sex, obesity, diabetes and other illnesses or conditions such as coronary artery disease, hypertension or cancer.

    People who took the fewest steps were socioeconomically disadvantaged, under psychological stress and not vaccinated, the study said.

    Age made a difference as well, but in an unexpected manner: People over 60 were not impacted by the pandemic, the study found — they continued to keep their steps up.

    Oddly, it was younger people between 18 and 30 whose step counts were most impacted, Brittain said. “In fact, we found every 10-year decrease in age was associated with a 243 step reduction per day.”

    “If this persists over time, it could certainly raise the risk of cardiovascular disease, obesity, hypertension, diabetes and other conditions strongly linked to being sedentary,” Brittian said. “However, it’s too soon to know whether this trend will last.”

    Why would a younger generations lose steps while older people did not?

    “I think it’s difficult to interpret because it’s only 600 steps, which you could argue is what some people would get simply walking into work and through their day,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, who was not involved in the research. “I think the question is who is more likely to work from home?”

    Younger generations make up the majority of workers in technology, software and other professions that are able to work from anywhere, “whereas older people may have less of those jobs,” Freeman said.

    Whatever the reason, the study data shows that people were not moving as much during the pandemic as they used to. That is worrisome, Freeman added.

    “If this trend remains, we should really be cognizant that if you’re going to work from home, use either a standing, treadmill or bike desk,” he said, adding that managers of remote employees should “insist people take periodic breaks for people to do exercise, which also is proven to improve mental clarity and acuity,” he said.

    Health professionals should always be talking to their patients about activity levels, but “the impact of Covid-19 might make those kinds of messages all the more important to discuss with patients,” Brittain said.

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  • Scientists parse another clue to possible origins of Covid-19 as WHO says all possibilities ‘remain on the table’ | CNN

    Scientists parse another clue to possible origins of Covid-19 as WHO says all possibilities ‘remain on the table’ | CNN



    CNN
     — 

    There’s a tantalizing new clue in the hunt for the origins of the Covid-19 pandemic.

    A new analysis of genetic material collected from January to March 2020 at the Huanan Seafood Market in Wuhan, China, has uncovered animal DNA in samples already known to be positive for SARS-CoV-2, the coronavirus that causes Covid-19. A significant amount of that DNA appears to belong to animals known as raccoon dogs, which were known to be traded at the market, according to officials with the World Health Organization, who addressed the new evidence in a news briefing on Friday.

    The connection to raccoon dogs came to light after Chinese researchers shared raw genetic sequences taken from swabbed specimens collected at the market early in the pandemic. The sequences were uploaded in late January 2023, to the data sharing site GISAID, but have recently been removed.

    An international team of researchers noticed them and downloaded them for further study, the WHO officials said Friday.

    The new findings – which have not yet been publicly posted – do not settle the question of how the pandemic started. They do not prove that raccoon dogs were infected with SARS-CoV-2, nor do they prove that raccoon dogs were the animals that first infected people.

    But because viruses don’t survive in the environment outside of their hosts for long, finding so much of the genetic material from the virus intermingled with genetic material from raccoon dogs is highly suggestive that they could have been carriers, according to scientists who worked on the analysis. The analysis was led by Kristian Andersen, an immunologist and microbiologist at Scripps Research; Edward Holmes, a virologist at the University of Sydney; Michael Worobey, an evolutionary biologist at the University of Arizona. These three scientists, who have been digging into the origins of the pandemic, were interviewed by reporters for The Atlantic magazine. CNN has reached out to Andersen, Holmes and Worobey for comment.

    The details of the international analysis were first reported Thursday by The Atlantic.

    The new data is emerging as Republicans in Congress have opened investigations into the pandemic’s origin. Previous studies provided evidence that the virus likely emerged naturally in market, but could not point to a specific origin. Some US agencies, including a recent US Department of Energy assessment, say the pandemic likely resulted from a lab leak in Wuhan.

    In the news briefing on Friday, WHO Director-General Tedros Adhanom Ghebreyesus said the organization was first made aware of the sequences on Sunday.

    “As soon as we became aware of this data, we contacted the Chinese CDC and urged them to share it with WHO and the international scientific community so it can be analyzed,” Tedros said.

    WHO also convened its Scientific Advisory Group for the Origins of the Novel Pathogens, known as SAGO, which has been investigating the roots of the pandemic, to discuss the data on Tuesday. The group heard from Chinese scientists who had originally studied the sequences, as well as the group of international scientists taking a fresh look at them.

    WHO experts said in the Friday briefing that the data are not conclusive. They still can’t say whether the virus leaked from a lab, or if it spilled over naturally from animals to humans.

    “These data do not provide a definitive answer to the question of how the pandemic began, but every piece of data is important in moving us closer to that answer,” Tedros said.

    What the sequences do prove, WHO officials said, is that China has more data that might relate to the origins of the pandemic that it has not yet shared with the rest of the world.

    “This data could have, and should have, been shared three years ago,” Tedros said. “We continue to call on China to be transparent in sharing data and to conduct the necessary investigations and share results.

    “Understanding how the pandemic began remains a moral and scientific imperative.”

    CNN has reached out to the Chinese scientists who first analyzed and shared the data, but has not received a reply.

    The Chinese researchers, who are affiliated with that country’s Center for Disease Control and Prevention, had shared their own analysis of the samples in 2022. In that preprint study posted last year, they concluded that “no animal host of SARS-CoV2 can be deduced.”

    The research looked at 923 environmental samples taken from within the seafood market and 457 samples taken from animals, and found 63 environmental samples that were positive for the virus that causes Covid-19. Most were taken from the western end of the market. None of the animal samples, which were taken from refrigerated and frozen products for sale, and from live, stray animals roaming the market, were positive, the Chinese authors wrote in 2022.

    When they looked at the different species of DNA represented in the environmental samples, the Chinese authors only saw a link to humans, but not other animals.

    When an international team of researchers recently took at fresh look at the genetic material in the samples – which were swabbed in and around the stalls of the market – using an advanced genetic technique called metagenomics, scientists said they were surprised to find a significant amount of DNA belonging to raccoon dogs, a small animal related to foxes. Raccoon dogs can be infected with the virus that causes Covid-19 and have been high on the list of suspected animal hosts for the virus.

    “What they found is molecular evidence that animals were sold at that market. That was suspected, but they found molecular evidence of that. And also that some of the animals that were there were susceptible to SARS-CoV2 infection, and some of those animals include raccoon dogs,” said Maria Van Kerkhove, WHO’s technical lead for Covid-19, in Friday’s briefing.

    “This doesn’t change our approach to studying the origins of Covid-19. It just tells us that more data exists, and that data needs to be shared in full,” she said.

    Van Kerkhove said that until the international scientific community is able to review more evidence, “all hypotheses remain on the table.”

    Some experts found the new evidence persuasive, if not completely convincing, of an origin in the market.

    “The data does point even further to a market origin,” Andersen, the Scripps Research evolutionary biologist who attended the WHO meeting and is one of the scientists analyzing the new data, told the magazine Science.

    The assertions made over the new data quickly sparked debate in the scientific community.

    Francois Balloux, director of the Genetics Institute at University College London, said the fact that the new analysis had not yet been publicly posted for scientists to scrutinize, but had come to light in news reports, warranted caution.

    “Such articles really don’t help as they only polarise the debate further,” Balloux posted in a thread on Twitter. “Those convinced by a zoonotic origin will read it as final proof for their conviction, and those convinced it was a lab leak will interpret the weakness of the evidence as attempts of a cover-up.”

    Other experts, who were not involved in the analysis, said the data could be key to showing the virus had a natural origin.

    Felicia Goodrum is an immunobiologist at the University of Arizona, who recently published a review of all available data for the various theories behind the pandemic’s origin.

    Goodrum says the strongest proof for a natural spillover would be to isolate the virus that causes Covid-19 from an animal that was present in the market in 2019.

    “Clearly, that is impossible, as we cannot go back in time any more than we have through sequencing, and no animals were present at the time sequences could be collected. To me, this is the next best thing,” Goodrum said in an email to CNN.

    In the WHO briefing, Van Kerkhove said that the Chinese CDC researchers had uploaded the sequences to GISAID as they were updating their original research. She said their first paper is in the process of being updated and resubmitted for publication.

    “We have been told by GISAID that the data from China’s CDC is being updated and expanded,” she said.

    Van Kerkhove said on Friday that what WHO would like to be able to do is to find the source of where the animals came from. Were they wild? Were they farmed?

    She said in the course of its investigation into the pandemic’s origins, WHO had repeatedly asked China for studies to trace the animals back to their source farms. She said WHO had also asked for blood tests on people who worked in the market, as well as tests on animals that may have come from the farms.

    “Share the data,” Dr. Mike Ryan, executive director of WHO’s health emergencies program, said Friday, addressing scientists around the world who might have relevant information. “Let science do the work, and we will get the answers.”

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  • Why is it difficult for children to get a bed at pediatric hospitals? It’s more complicated than you think | CNN

    Why is it difficult for children to get a bed at pediatric hospitals? It’s more complicated than you think | CNN



    CNN
     — 

    Effie Schnacky was wheezy and lethargic instead of being her normal, rambunctious self one February afternoon. When her parents checked her blood oxygen level, it was hovering around 80% – dangerously low for the 7-year-old.

    Her mother, Jaimie, rushed Effie, who has asthma, to a local emergency room in Hudson, Wisconsin. She was quickly diagnosed with pneumonia. After a couple of hours on oxygen, steroids and nebulizer treatments with little improvement, a physician told Schnacky that her daughter needed to be transferred to a children’s hospital to receive a higher level of care.

    What they didn’t expect was that it would take hours to find a bed for her.

    Even though the respiratory surge that overwhelmed doctor’s offices and hospitals last fall is over, some parents like Schnacky are still having trouble getting their children beds in a pediatric hospital or a pediatric unit.

    The physical and mental burnout that occurred during the height of the Covid-19 pandemic has not gone away for overworked health care workers. Shortages of doctors and technicians are growing, experts say, but especially in skilled nursing. That, plus a shortage of people to train new nurses and the rising costs of hiring are leaving hospitals with unstaffed pediatric beds.

    But a host of reasons building since well before the pandemic are also contributing. Children may be the future, but we aren’t investing in their health care in that way. With Medicaid reimbursing doctors at a lower rate for children, hospitals in tough situations sometimes put adults in those pediatric beds for financial reasons. And since 2019, children with mental health crises are increasingly staying in emergency departments for sometimes weeks to months, filling beds that children with other illnesses may need.

    “There might or might not be a bed open right when you need one. I so naively just thought there was plenty,” Schnacky told CNN.

    The number of pediatric beds decreasing has been an issue for at least a decade, said Dr. Daniel Rauch, chair of the Committee on Hospital Care for the American Academy of Pediatrics.

    By 2018, almost a quarter of children in America had to travel farther for pediatric beds as compared to 2009, according to a 2021 paper in the journal Pediatrics by lead author Dr. Anna Cushing, co-authored by Rauch.

    “This was predictable,” said Rauch, who has studied the issue for more than 10 years. “This isn’t shocking to people who’ve been looking at the data of the loss in bed capacity.”

    The number of children needing care was shrinking before the Covid-19 pandemic – a credit to improvements in pediatric care. There were about 200,000 fewer pediatric discharges in 2019 than there were in 2017, according to data from the US Department of Health and Human Services.

    “In pediatrics, we have been improving the ability we have to take care of kids with chronic conditions, like sickle cell and cystic fibrosis, and we’ve also been preventing previously very common problems like pneumonia and meningitis with vaccination programs,” said Dr. Matthew Davis, the pediatrics department chair at Ann & Robert H. Lurie Children’s Hospital of Chicago.

    Pediatrics is also seasonal, with a typical drop in patients in the summer and a sharp uptick in the winter during respiratory virus season. When the pandemic hit, schools and day cares closed, which slowed the transmission of Covid and other infectious diseases in children, Davis said. Less demand meant there was less need for beds. Hospitals overwhelmed with Covid cases in adults switched pediatric beds to beds for grownups.

    As Covid-19 tore through Southern California, small hospitals in rural towns like Apple Valley were overwhelmed, with coronavirus patients crammed into hallways, makeshift ICU beds and even the pediatric ward.

    Only 37% of hospitals in the US now offer pediatric services, down from 42% about a decade ago, according to the American Hospital Association.

    While pediatric hospital beds exist at local facilities, the only pediatric emergency department in Baltimore County is Greater Baltimore Medical Center in Towson, Maryland, according to Dr. Theresa Nguyen, the center’s chair of pediatrics. All the others in the county, which has almost 850,000 residents, closed in recent years, she said.

    The nearby MedStar Franklin Square Medical Center consolidated its pediatric ER with the main ER in 2018, citing a 40% drop in pediatric ER visits in five years, MedStar Health told CNN affiliate WBAL.

    In the six months leading up to Franklin Square’s pediatric ER closing, GBMC admitted an average of 889 pediatric emergency department patients each month. By the next year, that monthly average jumped by 21 additional patients.

    “Now we’re seeing the majority of any pediatric ED patients that would normally go to one of the surrounding community hospitals,” Nguyen said.

    In July, Tufts Medical Center in Boston converted its 41 pediatric beds to treat adult ICU and medical/surgical patients, citing the need to care for critically ill adults, the health system said.

    In other cases, it’s the hospitals that have only 10 or so pediatric beds that started asking the tough questions, Davis said.

    “Those hospitals have said, ‘You know what? We have an average of one patient a day or two patients a day. This doesn’t make sense anymore. We can’t sustain that nursing staff with specialized pediatric training for that. We’re going to close it down,’” Davis said.

    Registered nurses at Tufts Medical Center hold a

    Saint Alphonsus Regional Medical Center in Boise closed its pediatric inpatient unit in July because of financial reasons, the center told CNN affiliate KBOI. That closure means patients are now overwhelming nearby St. Luke’s Children’s Hospital, which is the only children’s hospital in the state of Idaho, administrator for St. Luke’s Children’s Katie Schimmelpfennig told CNN. Idaho ranks last for the number of pediatricians per 100,000 children, according to the American Board of Pediatrics in 2023.

    The Saint Alphonsus closure came just months before the fall, when RSV, influenza and a cadre of respiratory viruses caused a surge of pediatric patients needing hospital care, with the season starting earlier than normal.

    The changing tide of demand engulfed the already dwindling supply of pediatric beds, leaving fewer beds available for children coming in for all the common reasons, like asthma, pneumonia and other ailments. Additional challenges have made it particularly tough to recover.

    Another factor chipping away at bed capacity over time: Caring for children pays less than caring for adults. Lower insurance reimbursement rates mean some hospitals can’t afford to keep these beds – especially when care for adults is in demand.

    Medicaid, which provides health care coverage to people with limited income, is a big part of the story, according to Joshua Gottlieb, an associate professor at the University of Chicago Harris School of Public Policy.

    “Medicaid is an extremely important payer for pediatrics, and it is the least generous payer,” he said. “Medicaid is responsible for insuring a large share of pediatric patients. And then on top of its low payment rates, it is often very cumbersome to deal with.”

    Pediatric gastroenterologist Dr. Howard Baron visits with a patient in 2020 in Las Vegas. A large portion of his patients are on Medicaid with reimbursement rates that are far below private insurers.

    Medicaid reimburses children’s hospitals an average of 80% of the cost of the care, including supplemental payments, according to the Children’s Hospital Association, a national organization which represents 220 children’s hospitals. The rate is far below what private insurers reimburse.

    More than 41 million children are enrolled in Medicaid and the Children’s Health Insurance Program, according to Kaiser Family Foundation data from October. That’s more than half the children in the US, according to Census data.

    At Children’s National Hospital in Washington, DC, about 55% of patients use Medicaid, according to Dr. David Wessel, the hospital’s executive vice president.

    “Children’s National is higher Medicaid than most other children’s hospitals, but that’s because there’s no safety net hospital other than Children’s National in this town,” said Wessel, who is also the chief medical officer and physician-in-chief.

    And it just costs more to care for a child than an adult, Wessel said. Specialty equipment sized for smaller people is often necessary. And a routine test or exam for an adult is approached differently for a child. An adult can lie still for a CT scan or an MRI, but a child may need to be sedated for the same thing. A child life specialist is often there to explain what’s going on and calm the child.

    “There’s a whole cadre of services that come into play, most of which are not reimbursed,” he said. “There’s no child life expert that ever sent a bill for seeing a patient.”

    Low insurance reimbursement rates also factor into how hospital administrations make financial decisions.

    “When insurance pays more, people build more health care facilities, hire more workers and treat more patients,” Gottlieb said.

    “Everyone might be squeezed, but it’s not surprising that pediatric hospitals, which face [a] lower, more difficult payment environment in general, are going to find it especially hard.”

    Dr. Benson Hsu is a pediatric critical care provider who has served rural South Dakota for more than 10 years. Rural communities face distinct challenges in health care, something he has seen firsthand.

    A lot of rural communities don’t have pediatricians, according to the American Board of Pediatrics. It’s family practice doctors who treat children in their own communities, with the goal of keeping them out of the hospital, Hsu said. Getting hospital care often means traveling outside the community.

    Hsu’s patients come from parts of Nebraska, Iowa and Minnesota, as well as across South Dakota, he said. It’s a predominantly rural patient base, which also covers those on Native American reservations.

    “These kids are traveling 100, 200 miles within their own state to see a subspecialist,” Hsu said, referring to patients coming to hospitals in Sioux Falls. “If we are transferring them out, which we do, they’re looking at travels of 200 to 400 miles to hit Omaha, Minneapolis, Denver.”

    Inpatient pediatric beds in rural areas decreased by 26% between 2008 and 2018, while the number of rural pediatric units decreased by 24% during the same time, according to the 2021 paper in Pediatrics.

    Steve Inglish, left, and registered nurse Nikole Hoggarth, middle, help a father with his daughter, who fell and required stiches, inside the emergency department at Jamestown Regional Medical Center in rural North Dakota in 2020.

    “It’s bad, and it’s getting worse. Those safety net hospitals are the ones that are most at risk for closure,” Rauch said.

    In major cities, the idea is that a critically ill child would get the care they need within an hour, something clinicians call the golden hour, said Hsu, who is the critical care section chair at the American Academy of Pediatrics.

    “That golden hour doesn’t exist in the rural population,” he said. “It’s the golden five hours because I have to dispatch a plane to land, to drive, to pick up, stabilize, to drive back, to fly back.”

    When his patients come from far away, it uproots the whole family, he said. He described families who camp out at a child’s bedside for weeks at a time. Sometimes they are hundreds of miles from home, unlike when a patient is in their own community and parents can take turns at the hospital.

    “I have farmers who miss harvest season and that as you can imagine is devastating,” Hsu said. “These aren’t office workers who are taking their computer with them. … These are individuals who have to live and work in their communities.”

    Back at GBMC in Maryland, an adolescent patient with depression, suicidal ideation and an eating disorder was in the pediatric emergency department for 79 days, according to Nguyen. For months, no facility had a pediatric psychiatric bed or said it could take someone who needed that level of care, as the patient had a feeding tube.

    “My team of physicians, social workers and nurses spend a significant amount of time every day trying to reach out across the state of Maryland, as well as across the country now to find placements for this adolescent,” Nguyen said before the patient was transferred in mid-March. “I need help.”

    Nguyen’s patient is just one of the many examples of children and teens with mental health issues who are staying in emergency rooms and sometimes inpatient beds across the country because they need help, but there isn’t immediately a psychiatric bed or a facility that can care for them.

    It’s a problem that began before 2020 and grew worse during the pandemic, when the rate of children coming to emergency rooms with mental health issues soared, studies show.

    Now, a nationwide shortage of beds exists for children who need mental health help. A 2020 federal survey revealed that the number of residential treatment facilities for children fell 30% from 2012.

    “There are children on average waiting for two weeks for placement, sometimes longer,” Nguyen said of the patients at GBMC. The pediatric emergency department there had an average of 42 behavioral health patients each month from July 2021 through December 2022, up 13.5% from the same period in 2017 to 2018, before the pandemic, according to hospital data.

    When there are mental health patients staying in the emergency department, that can back up the beds in other parts of the hospital, creating a downstream effect, Hsu said.

    “For example, if a child can’t be transferred from a general pediatric bed to a specialized mental health center, this prevents a pediatric ICU patient from transferring to the general bed, which prevents an [emergency department] from admitting a child to the ICU. Health care is often interconnected in this fashion,” Hsu said.

    “If we don’t address the surging pediatric mental health crisis, it will directly impact how we can care for other pediatric illnesses in the community.”

    Dr. Susan Wu, right, chats with a child who got her first dose of the Pfizer-BioNtech Covid-19 vaccine at Children's Hospital Arcadia Speciality Care Center in Arcadia, California, in 2022.

    So, what can be done to improve access to pediatric care? Much like the reasons behind the difficulties parents and caregivers are experiencing, the solutions are complex:

    • A lot of it comes down to money

    Funding for children’s hospitals is already tight, Rauch said, and more money is needed not only to make up for low insurance reimbursement rates but to competitively hire and train new staff and to keep hospitals running.

    “People are going to have to decide it’s worth investing in kids,” Rauch said. “We’re going to have to pay so that hospitals don’t lose money on it and we’re going to have to pay to have staff.”

    Virtual visits, used in the right situations, could ease some of the problems straining the pediatric system, Rauch said. Extending the reach of providers would prevent transferring a child outside of their community when there isn’t the provider with the right expertise locally.

    • Increased access to children’s mental health services

    With the ongoing mental health crisis, there’s more work to be done upstream, said Amy Wimpey Knight, the president of CHA.

    “How do we work with our school partners in the community to make sure that we’re not creating this crisis and that we’re heading it off up there?” she said.

    There’s also a greater need for services within children’s hospitals, which are seeing an increase in children being admitted with behavioral health needs.

    “If you take a look at the reasons why kids are hospitalized, meaning infections, diabetes, seizures and mental health concerns, over the last decade or so, only one of those categories has been increasing – and that is mental health,” Davis said. “At the same time, we haven’t seen an increase in the number of mental health hospital resources dedicated to children and adolescents in a way that meets the increasing need.”

    Most experts CNN spoke to agreed: Seek care for your child early.

    “Whoever is in your community is doing everything possible to get the care that your child needs,” Hsu said. “Reach out to us. We will figure out a way around the constraints around the system. Our number one concern is taking care of your kids, and we will do everything possible.”

    Nguyen from GBMC and Schimmelpfennig from St. Luke’s agreed with contacting your primary care doctor and trying to keep your child out of the emergency room.

    “Anything they can do to stay out of the hospital or the emergency room is both financially better for them and better for their family,” Schimmelpfennig said.

    Knowing which emergency room or urgent care center is staffed by pediatricians is also imperative, Rauch said. Most children visit a non-pediatric ER due to availability.

    “A parent with a child should know where they’re going to take their kid in an emergency. That’s not something you decide when your child has the emergency,” he said.

    Jaimie and Effie Schnacky now have an asthma action plan after the 7-year-old's hospitalization in February.

    After Effie’s first ambulance ride and hospitalization last month, the Schnacky family received an asthma action plan from the pulmonologist in the ER.

    It breaks down the symptoms into green, yellow and red zones with ways Effie can describe how she’s feeling and the next steps for adults. The family added more supplies to their toolkit, like a daily steroid inhaler and a rescue inhaler.

    “We have everything an ER can give her, besides for an oxygen tank, at home,” Schnacky said. “The hope is that we are preventing even needing medical care.”

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